Hagop M. Kantarjian

Treatment of Acute Lymphoblastic Leukemia in Adolescents and Young Adults

Acute lymphoblastic leukemia (ALL) has a bimodal age distribution with an early peak between 2 and 6 yr of age and a second peak in the fifth decade. The yearly incidence of ALL in the United States is about 3000 new childhood cases and 1500–2000 new adult cases. Although 70–80% of children with ALL are cured with current therapies, the results in adult ALL remain modest, despite implementation of treatment strategies that have proved successful in children. In pediatric and adult trials, age remains a major prognostic factor: outcome gradually worsens with increasing age. Adolescents and young adults (aged 12–20 yr) with ALL do worse than children but better than older adults. Younger adults are arbitrarily treated on pediatric or adult protocols, which confounds analyses of treatment outcome in this age group. In this chapter we discuss the treatment results for young adults with ALL on childhood and adult protocols, with their particular characteristics, and we propose future therapeutic plans.

Prediction of response and survival in patients with chronic-phase chronic myeloid leukemia treated with omacetaxine mepesuccinate: logistic regression and landmark analyses.

Although many chronic myeloid leukemia (CML) patients initially do well with tyrosine kinase inhibitors (TKIs), some patients develop resistance or intolerance to multiple TKIs and need further therapy. Omacetaxine mepesuccinate (omacetaxine), a protein synthesis inhibitor, represents a new class of treatment that can produce major cytogenetic response (MCyR) in patients with CML who have developed resistance or intolerance to TKIs. The US Food and Drug Administration approved subcutaneous omacetaxine for treatment of CML in chronic-phase (CP) and accelerated-phase patients, with resistance or intolerance to two or more TKIs based on efficacy analysis of a subset of patients from two phase 2, open-label, international, multicenter studies.1, 2 Among the 76 evaluable patients with CML-CP in the efficacy analysis, MCyR was reported in 14 patients (18.4%), including confirmed complete cytogenetic response (CCyR) in six patients (7.9%), with a median MCyR duration of 12.5 months.2, 3 Median progression-free survival (PFS) and overall survival (OS) in CML-CP patients were 9.6 months (95% confidence interval (CI) 6.8–11.3 months) and 40.3 months (95% CI 23.8 months–not reached), respectively.