Young Adults with Leukemia: Why It's Better to Treat Them like Kids
Jenn Georges recently completed her master's degree and started a new job. She is busy planning her upcoming wedding. With her adult life on track, the 24-year-old doesn't mind that when it came to fighting leukemia, she was treated -- in one way -- like a child.
In 2009, shortly after graduating from the University of Illinois, Georges came down with what she thought might be the swine flu. After three days of tests and transfusions in a downstate hospital, doctors there told her, "It's leukemia." They recommended she go to an academic medical center for the best possible treatment.
The Lombard native returned home to get her care at the University of Chicago Medicine. In her initial meeting with hematologist/oncologist Wendy Stock, MD, Georges learned that a clinical trial testing a pediatric protocol for young adults battling acute lymphoblastic leukemia could give her the best chance at survival. She told Stock to "sign me up."
Georges is part of a distinct group of patients referred to as AYAs: adolescents and young adults with cancer. Until recently, most young adults with leukemia were treated on adult protocols. But a 2008 retrospective study conducted by Stock and her colleagues observed that AYAs treated on pediatric regimens had better outcomes. "The results showed 63 percent disease-free survival for individuals on pediatric trials versus 39 percent for those on adult trials," said Stock, an expert on leukemia and lead author of the study published in Blood.
This important observation led to the clinical trial that enrolled Georges and more than 300 other patients, ages 16 to 39 across the country. Designed and led by three national adult oncology groups, the ongoing cooperative study is assessing toxicity, tolerance and compliance.
"While the adult and pediatric chemotherapy drugs are the same, the doses and schedules are different," Stock explained. "The intensity of the pediatric therapy gets harder to tolerate as patients age."
Stock and the other researchers are also seeking to establish why five-year survival rates for AYA patients (currently 70 percent) have not kept pace with the increased rates of survival seen in younger children with leukemia (almost 80 percent). "In addition to evaluating treatments, we are looking at the personal challenges faced by AYA patients," she said, "By examining characteristics such as demographics, economics and social support, we hope to identify any significant barriers faced by this population."
New Program Brings Comprehensive Care to AYAs
In August 2012, the University of Chicago Medicine began a new Adolescent and Young Adult Oncology Program to offer diagnostic, treatment and support services for individuals, ages 15 to 30, with leukemia or lymphoma. The clinic's multidisciplinary medical team includes adult and pediatric hematologists/oncologists, advanced practice nurses and social workers as well as specialists in survivorship, psychology, fertility and genetics. In addition to facilitating coordinated care, the focused setting will provide more opportunities for innovative clinical research on therapeutic trials, quality of life, survivorship, medical economics and psychosocial issues.
Stock considers the AYA program a unique opportunity to assist more patients like Georges as they navigate the medical system and deal with the challenges of fighting cancer. "Jenn took an active role in her care and didn't let the diagnosis limit her life during treatment," Stock said. "We want to help more young adults have the optimism and independence she had when battling cancer."
A version of this story originally ran in the Fall 2012 issue of Imagine, a quarterly magazine published by the University of Chicago Medicine.
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