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    Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Postinduction Treatment for Specific ALL Subgroups

    Table 3. Outcome According to Treatment Protocol for Adolescents and Young Adults with ALL

    Site and Study Group Adolescent and Young Adult Patients (No.) Median age (y) Survival (%)
    ALL = acute lymphoblastic leukemia; EFS = event-free survival; OS = overall survival.
    AEIOP = Associazione Italiana Ematologia Oncologia Pediatrica; CALGB = Cancer and Leukemia Group B; CCG = Children's Cancer Group; DCOG = Dutch Childhood Oncology Group; FRALLE = French Acute Lymphoblastic Leukaemia; GIMEMA = Gruppo Italiano Malattie e Matologiche dell'Adulto; HOVON = Dutch-Belgian Hemato-Oncology Cooperative Group; LALA = France-Belgium Group for Lymphoblastic Acute Leukemia in Adults; MRC = Medical Research Council (United Kingdom); NOPHO = Nordic Society for Pediatric Hematology and Oncology; UKALL = United Kingdom Acute Lymphoblastic Leukaemia.
    United States[29]
    CCG (Pediatric) 197 16 67, OS 7 y
    CALGB (Adult) 124 19 46
    FRALLE 93 (Pediatric) 77 16 67 EFS
    LALA 94 100 18 41
    AEIOP (Pediatric) 150 15 80, OS 2 y
    GIMEMA (Adult) 95 16 71
    DCOG (Pediatric) 47 12 71 EFS
    HOVON 44 20 38
    NOPHO 92 (Pediatric) 36 16 74, OS 5 y
    Adult ALL 99 18 39
    United Kingdom[32]
    MRC ALL (Pediatric) 61 15-17 71, OS 5 y
    UKALL XII (Adult) 67 15-17 56


    Adolescents with ALL appear to be at higher risk than younger children for developing therapy-related complications, including osteonecrosis, deep venous thromboses, and pancreatitis.[31,39] Before the use of postinduction intensification for treatment of ALL, osteonecrosis was infrequent. The improvement in outcome for children and adolescents aged 10 years and older was accompanied by an increased incidence of osteonecrosis.

    The weight-bearing joints are affected in 95% of patients who develop osteonecrosis and operative interventions are needed for management of symptoms and impaired mobility in more than 40% of cases. The majority of the cases are diagnosed within the first 2 years of therapy and often the symptoms are recognized during maintenance.

    Evidence (osteonecrosis):

    1. In the CCG-1961 high-risk ALL study, alternate-week dosing of dexamethasone was compared with standard continuous dexamethasone during delayed intensification to see if the osteonecrosis risk could be reduced.[39]
      • The median age at symptom onset was 16 years.
      • The cumulative incidence was higher in adolescents and young adults aged 16 to 21 years (20% at 5 years) than in those aged 10 to 15 years (9.9%) or in patients aged 1 to 9 years (1%).
      • Operative interventions are needed for management of symptoms and impaired mobility in more than 40% of cases.
      • The use of alternate-week dosing of dexamethasone as compared with standard continuous dexamethasone during delayed intensification in CCG-1961 reduced the risk of osteonecrosis. The greatest impact was seen in females aged 16 to 21 years, who showed the highest incidence of osteonecrosis with standard therapy containing continuous dexamethasone; osteonecrosis was reduced with alternate-week dexamethasone postinduction (57.6% to 5.6%).
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