The UKALL 2003 protocol has a Young Adult Appendix which elaborates on research into adult versus paediatric treatment regimes for young adults where it is stated that in the past "adolescents have received ALL therapy according to either paediatric or adult clinical trials, determined only by local referrals to paedatric or adult physicians". GPs decide the treatment protocol? Oh dear. Dr John - you have to decide a young adult's ALL treatment!
Fortunately, for Lucia and H., they have been put on the UKALL 2003 (paediatric) trial. Why?
Various treatment protocols in trials in several countries have found that pediatric protocols are more effective for young adults than adult protocols (the stats are on p. 128 of the protocol) . Evidence from previous UKALL trials and overseas trials is not conclusive yet but the Event Free Survival (EFS) rates and Overall Survival (OS) rates seem to be better for young adults receiving paediatric as opposed to adult treatment.
The evidence is not considered to be conclusve by the medical profession as sampling (i.e.patients) has not been sufficient, but it is strong enough to comsider further testing.
So an aim, albeit not the principle one, of the UKALL 2003 Trial is to evaluate the use of a slightly modified paediatric regime in young adults.
Differences between young adults and adults at prognosis do not seem to be important. However, there are major differences in treatment regimes.
UKALL 2003 is slightly modified for young adults. Children are first evaluated into risk groups at Day 8 when Slow Early Responders are automatically put on Regimen C. However, the USCCG 1882 trial showed no benefits to this for young adults with "normal" ALL (i.e. with no complications arising from genetic defects who automatically go onto Regime C). At Day 28 Mean Residual Disease High Risk young adults are randomised between Regimes B (with two Delayed Intensification phases) and C. Low Risk patients follow Regime B with randomisation between one and two Delayed Intensifications. No young adults follow Regime A, I assume because their age does put them at higher risk than children.
So, although the Royal Manchester Children's Hospital does not have a young adult unit as Manchester's other cancer hospital does, at RMCH you do get the advantage of following the paediatric UKALL 2003 protocol whilst at Christies you follow the adult UKALL XII protocol.
And all the more reason that the new RMCH should have a young adult unit.
And the message to the referrers is send your ALL young adult patients to a paediatric hospital.
Disclaimer: I should reiterate that this applies to T-cell ALL, not B-cell that goes on another procotol that I know nothing about, and certainly not other forms of leukeamia.