Pediatric-inspired regimens and HSCT for AYA patients with ALL

A systematic review, evaluating pediatric-inspired regimens and hematopoietic stem cell transplantation (HSCT) for the treatment of adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL), was published in Blood Advances by Sereda et al. This review aimed to provide a focused analysis of pediatric-inspired regimens vs conventional, asparaginase-free adult regimens in AYA patients with ALL who were receiving first-line therapy and to compare HSCT vs no HSCT in AYA patients with ALL who were in first complete remission (CR). The meta-analyses included 19 studies comparing regimens (N = 3,607) and seven studies comparing HSCT to no HSCT (N = 7,492).  

Key data: Meta-analyses of overall survival (OS) favored pediatric-inspired regimens, with a pooled relative risk (RR) at 5 years of 1.40 (95% confidence interval [CI], 1.18–1.65; six studies). Event-free survival (EFS) was generally higher with pediatric regimens vs adult regimens, with a pooled EFS RR at 5 years of 1.80 (95% CI, 1.13–2.85; five studies). There was no significant difference in CR rates in pediatric vs adult regimens. Most studies did not compare safety between pediatric and adult regimens. OS following HSCT varied between studies, while disease-free survival (DFS) was found to be lower with HSCT vs without HSCT. Findings regarding relapse following HSCT were inconsistent across studies and time points. 

Key learning: Findings from this review suggest that pediatric-inspired regimens may result in improved survival outcomes vs adult regimens, while HSCT may lead to inferior overall survival and DFS in AYA patients with ALL. Comparative safety outcomes were rarely reported, precluding conclusions on safety outcomes. Further studies are warranted to confirm and expand these findings in specific ALL subgroups.