Showing posts with label Young Adults. Show all posts
Showing posts with label Young Adults. Show all posts
Tuesday, March 1, 2011
Teenage and Young Adult cancer treatment consultation
The UK Department of Health is conducting the following until 11 April:
Monday, April 30, 2007
Paediatric Approaches to ALL
We posted earlier about the advantages of paediatric protocols in the treatment of Acute Lymphoblastic Leukaemia in young adults.
There now seems to be evidence that paediatric protocols may be advantageous up to the age of 40 or beyond!
In the French GRAALL-2003 trial a paediatric-type protocol was applied to adults and showed significantly increased rates of 2-year Event Free Survival and Overall Survival in comparison with the earlier LALA-94 trial adult protocol. The results were even more impressive for T-cell lineage ALL.
Link to abstract of presentation at the 2006 American Society of Hematology conference here.
At the same conference the Canadian Princess Margaret Hospital presented evidence that a modified Dana Farber Cancer Institute pediatric ALL protocol (DFCI 91-01) was beneficial for adults.
There now seems to be evidence that paediatric protocols may be advantageous up to the age of 40 or beyond!
In the French GRAALL-2003 trial a paediatric-type protocol was applied to adults and showed significantly increased rates of 2-year Event Free Survival and Overall Survival in comparison with the earlier LALA-94 trial adult protocol. The results were even more impressive for T-cell lineage ALL.
Link to abstract of presentation at the 2006 American Society of Hematology conference here.
At the same conference the Canadian Princess Margaret Hospital presented evidence that a modified Dana Farber Cancer Institute pediatric ALL protocol (DFCI 91-01) was beneficial for adults.
Thursday, March 29, 2007
UKALL 2003 - Young Adults II
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.
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.
Tuesday, March 27, 2007
UKALL 2003 - Young Adults
Lucia draws my attention to the fact that in latest version of the UKALL 2003 (posted February 2007 - link on right) has now increased the age range eligibility to 19 + 364 days. The protocol has a Young Adult Appendix which elaborates on research into adult versus paediatric treatment regimes for young adults - next post.
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