Pediatric Regimen Better for Young Adults with AML

While acute myeloid leukemia affects all age groups, treatment differs for pediatric patients compared with older adults. The question, though, is how to treat newly diagnosed adolescents and young adults—with the intensive childhood regimen of high-dose chemotherapy and an allogeneic transplant (when the patient receives donor stem cells after high-dose chemotherapy has killed off the cancer cells and healthy stem cells) or the more mild adult regimen of autologous transplant (when the patient is re-infused with stem cells from his or her own body that were collected before chemotherapy)?

Researchers from a multi-center trial retrospectively examined outcomes in 517 patients, ages 16 to 21 years, with AML who were treated between 1986 and 2008. Of the 13 trials examined, five were conducted by the Childhood Oncology Group (COG), which treated patients with an allogeneic transplant, whereas the remaining eight trials, conducted by two adult oncology cooperative groups, Southwest Oncology Group (SWOG) and Cancer and Leukemia Group B 3 (CALGB3), treated patients with autologous transplants.

At 10 years, there was a clear difference in overall survival favoring the COG-treated patients (45 percent versus 36 percent). While the study only examined patients with an age range of six years, researchers noticed a marked difference among the younger patients (16 to 18 years) and older patients (19 to 21 years) in the studies. It was noted that younger patients had a 43 percent 10-year survival rate compared with 32 percent for patients. The risk of relapse was also lower in the COG studies. One negative, however, was higher rate of treatment-related deaths in the COG studies compared with the CALGB3 and SWOG studies.