By Regina Nuzzo
Young leukemia and lymphoma patients today have better survival, but obstacles still remain
By Regina Nuzzo
Teenagers and young adults recently diagnosed with lymphoma or leukemia can expect to live longer than those who were diagnosed in the 1980s, according to a study in the Nov. 1, 2009, Cancer. But their survival rate still generally lags behind that of children and, in some cases, behind older adults diagnosed with the same diseases.
“Overall, the message of the study is optimistic,” says oncologist Dianne Pulte of the University of Medicine and Dentistry of New Jersey, in Newark, who led the study. “Survival in hematologic malignancies in adolescents and young adults is high and, in general, improving.” But the study also highlights treatment- and insurance-related obstacles, she says.
Pulte and colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) database, a population-based cancer registry in the U.S. They looked at trends in five- and 10-year relative survival rates for 15- to 24-year-olds diagnosed with blood-related cancers since 1980. (Relative survival rates compare survival of cancer patients with survival of the general population.)
Compared with those diagnosed in the early 1980s, patients in the early 2000s had better outcomes. Ten-year relative survival rates increased from 80 to 93 percent for Hodgkin lymphoma, from 56 to 76 percent for non-Hodgkin lymphoma, from 31 to 52 percent for acute lymphoblastic leukemia (ALL), and from 15 to 45 percent for acute myelogenous leukemia (AML).
The greatest success story has been in chronic myeloid leukemia (CML), with 10-year relative survival rates increasing from 0 to 75 percent. Initially, says pediatric oncologist Barton Kamen, the former chief medical officer of the Leukemia & Lymphoma Society, bone marrow transplantation likely helped improve the previously dismal outlook for CML patients. Then the 2001 approval of imatinib (Gleevec), a targeted enzyme inhibitor, boosted survival rates even further. “Gleevec,” Kamen says, “was the eureka moment.”
In contrast, AML survival for this group is still surprisingly low, Pulte says. Younger children and older adults have much better outcomes, she notes, even though AML is biologically similar among different ages. This suggests that access to care is probably to blame, she says. Teens and young adults are less likely to have health insurance, which delays diagnosis and jeopardizes good treatment—an obstacle that affects people with any cancer, but especially those diagnosed with the potentially curable acute leukemias. Even if they have insurance, people may not have the time and resources to get the care they need. Society could improve survival in this age group even without medical advances, Pulte says, “simply by finding some way to make sure that no patient receives less-than-optimal care because of financial status.”
Treatment-related challenges exist, too. “Adolescents and young adults are better able to recover from chemotherapy than older adults,” Pulte says, “but their recovery is slower than that of children.” That means typical adult chemotherapy might be too weak and childhood regimens too toxic.
Standard treatments for teenagers and young adults are still evolving. So while the study gives a good “real-life” snapshot of trends in community-based treatment, it probably missed any recent improvements being evaluated at specialized centers, says Gregory Plautz, a pediatric oncologist at the Cleveland Clinic Children’s Hospital.
One such innovation is “pediatric-inspired” treatment, Kamen says. An ongoing clinical trial is investigating the extent to which a chemotherapy regimen commonly used for children with ALL will work in patients ages 16 and up. Pediatric oncologists have managed to solidly improve survival rates for patients with blood cancers, Kamen says. “So now we’re starting to treat adolescents and adults like kids.”