ALL Leukemia

SLIDES & TRANSCRIPTS
Monday, May 12, 2003

Working Group F: Adolescent ALL

James Nachman, M.D.
Richard A. Larson, M.D.

Slide 1:

DR. LARSON: This will be short. Our working group had approximately equal representation between pediatric oncologists and adult oncologists, and quite an animated but friendly discussion about what we could learn from each other about the treatment of adolescents with ALL.

We started with Jim Nachman showing us the recently released data from the CCG-1961 study, suggesting in 253 patients, 16 years and older, about a 73 percent event free survival at four years.

So, together with the three series that Dr. Jeha presented this morning in her presentation, there seems to be some truth to the conclusion that adolescents have had a better outcome when treated by pediatric oncologists on pediatric protocols.

We discussed whether this reflected some sort of self selection by patients, that is, are patients who come to adult doctors different from those who are brought to pediatricians by their parents, and does that somehow figure into their adherence or compliance to protocols?

We also talked about possible center effects, since at least in the adult groups, 25 to 40 percent of our patients are treated in community oncology centers or affiliate hospitals, and not at main member university centers, and even some of those may not have a particularly dedicated leukemia program.

Slide 2:

There was a general consensus and considerable enthusiasm that this hypothesis needed to be addressed. Adult oncologists can achieve the same outcomes for adolescents with ALL as pediatric oncologists by using the same treatment regimen and, if this were not true, why not.

Again, is there some subtle selection bias by the patients themselves since biology they appear to, of course, be the same age, they have very similar, if not identical, pre-treatment characteristics.

Is there a difference in protocol adherence by the physicians and/or the patients? Are there differences in supportive care? So, by treating patients with the same treatment regimen, we would hope to address these issues.

We then talked about what such an inter-group study might be. The CCG, COG have designed a trial that we went through in some detail, in part because some components will be a little unusual to adult oncologists, but we thought that, with a little training, we could probably give the augmented BFM and the high dose methotrexate, and the Capizzi methotrexate.

We are not sure we can tell the difference between rapid early responders and slow responders, but we may be able to work around that.

Another competing regimen is the one that is already being studied by the Dana-Farber by the adult and pediatric group there and their consortium, which seems to be a bit more intensive than what the COG are proposing.

I think we had a very good discussion and there is a lot of enthusiasm for addressing this question, at least within the Southwest Oncology group,

If I can speak for Fred and the CALGB, we would, I think, like to pursue this approach with one or more of the pediatric groups. Are there any additions from people who were in the room and are still in this room? Any questions? Good, thank you.