***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Pretreatment cytogenetics is a known predictor of outcome in hematologic malignancies . However , its usefulness in adult acute lymphoblastic leukemia ( ALL ) is generally limited to the presence of the Philadelphia ( Ph ) chromosome because of the low incidence of other recurrent abnormalities . We present central ly review ed cytogenetic data from 1522 adult patients enrolled on the Medical Research Council ( MRC ) UKALLXII/Eastern Cooperative Oncology Group ( ECOG ) 2993 trial . The incidence and clinical associations for more than 20 specific chromosomal abnormalities are presented . Patients with a Ph chromosome , t(4;11)(q21;q23 ) , t(8;14)(q24.1;q32 ) , complex karyotype ( 5 or more chromosomal abnormalities ) , or low hypodiploidy/near triploidy ( Ho-Tr ) all had inferior rates of event-free and overall survival when compared with other patients . In contrast , patients with high hyperdiploidy or a del(9p ) had a significantly improved outcome . Multivariate analysis demonstrated that the prognostic relevance of t(8;14 ) , complex karyotype , and Ho-Tr was independent of sex , age , white cell count , and T-cell status among Ph-negative patients . The observation that Ho-Tr and , for the first time , karyotype complexity confer an increased risk of treatment failure demonstrates that cytogenetic subgroups other than the Ph chromosome can and should be used to risk stratify adults with ALL in future trials We analysed the long-term outcome of the L86 protocol using l-asparaginase ( l-asp ) , vincristine ( VCR ) and prednisolone ( PSL ) , collectively known as LVP or L97 protocol using LVP along with pirarubicin hydrochloride ( THP-ADR ) for 97 patients with acute lymphoblastic leukemia ( ALL ) diagnosed between 1986 and 2002 . No significant differences were seen in the two protocol s regarding the complete remission ( CR ) rate or survival . Seventy-five of the 97 patients ( 77 % ) achieved a CR . The overall survival ( OS ) and disease-free survival ( DFS ) rates were 32.1 % and 30.4 % at 10 years , respectively . By univariate analysis , we identified seven adverse factors for DFS which included the L2 subtype by French-American-British classification , hepatosplenomegaly , a white blood cell count of more than 30 × 109/L , a blast cell count of more than 10 × 109/L in the peripheral blood , hemoglobin concentration greater than 10 g/dL , a serum lactate dehydrogenase value greater than twice the upper limit of normal and the presence of the Philadelphia chromosome ( Ph ) . According to multivariate analysis , only the presence of Ph was a significant unfavourable factor for DFS and OS . In the 30 patients under 35 years of age without Ph , the OS in the 20 patients treated with L86 and in the 10 patients treated with L97 were 48 and 86 % , respectively ( P = 0.011 ) . These results indicate that intensified chemotherapy , such as the L97 protocol that includes an anthracycline , might be beneficial for younger patients who are Ph-negative The prognosis for higher risk childhood B-cell non-Hodgkin lymphoma has improved over the past 20 years but the optimal intensity of treatment has yet to be determined . Children 21 years old or younger with newly diagnosed B-cell non-Hodgkin lymphoma/B-cell acute lymphoblastic leukemia ( B-NHL/B-ALL ) with higher risk factors ( bone marrow [ BM ] with or without CNS involvement ) were r and omized to st and ard intensity French-American-British/Lymphoma Malignancy B ( FAB/LMB ) therapy or reduced intensity ( reduced cytarabine plus etoposide and deletion of 3 maintenance courses M2 , M3 , M4 ) . All patients with CNS disease had additional high-dose methotrexate ( 8 g/m2 ) plus extra intrathecal therapy . Fifty-one percent had BM involvement , 20 % had CNS involvement , and 29 % had BM and CNS involvement . One hundred ninety patients were r and omized . The probabilities of 4-year event-free survival ( EFS ) and survival ( S ) were 79 % + /- 2.7 % and 82 % + /- 2.6 % , respectively . In patients in remission after 3 cycles who were r and omized to st and ard versus reduced-intensity therapy , the 4-year EFS after r and omization was 90 % + /- 3.1 % versus 80 % + /- 4.2 % ( one-sided P = .064 ) and S was 93 % + /- 2.7 % versus 83 % + /- 4.0 % ( one-sided P = .032 ) . Patients with either combined BM/CNS disease at diagnosis or poor response to cyclophosphamide , Oncovin [ vincristine ] , prednisone ( COP ) reduction therapy had a significantly inferior EFS and S ( P < .001 ) . St and ard-intensity FAB/LMB therapy is recommended for children with high-risk B-NHL ( B-ALL with or without CNS involvement ) We performed a retrospective comparison of presenting features , planned treatment , complete remission ( CR ) rate , and outcome of 321 adolescents and young adults ( AYAs ) ages 16 to 20 years with newly diagnosed acute lymphoblastic leukemia ( ALL ) who were treated on consecutive trials in either the Children 's Cancer Group ( CCG ) or the Cancer and Leukemia Group B ( CALGB ) from 1988 to 2001 .  CR rates were identical , 90 % for both CALGB and CCG AYAs . CCG AYAs had a 63 % event-free survival ( EFS ) and 67 % overall survival ( OS ) at 7 years in contrast to the CALGB AYAs , in which 7-year EFS was only 34 % ( P < .001 ; relative hazard rate [ RHR ] = 2.2 ) and OS was 46 % ( P < .001 ; RHR = 1.9 ) . While CALGB AYAs aged 16 to 17 years achieved similar outcomes to all CCG AYAs with a 7-year EFS of 55 % , the EFS for 18- to 20-year-old CALGB patients was only 29 % . Comparison of the regimens showed that CCG AYAs received earlier and more intensive central nervous system prophylaxis and higher cumulative doses of nonmyelosuppressive agents . There were no differences in outcomes of those who reached maintenance therapy on time compared with those who were delayed . Based on these observations , a prospect i ve study for AYAs with ALL using the more successful approach of the CCG has been initiated PURPOSE Retrospective comparisons have suggested that adolescents or teenagers with acute lymphoblastic leukemia ( ALL ) benefit from pediatric rather than adult chemotherapy regimens . Thus , the aim of the present phase II study was to test a pediatric-inspired treatment , including intensified doses of nonmyelotoxic drugs , such as prednisone , vincristine , or L-asparaginase , in adult patients with ALL up to the age of 60 years . PATIENTS AND METHODS Between 2003 and 2005 , 225 adult patients ( median age , 31 years ; range , 15 to 60 years ) with Philadelphia chromosome-negative ALL were enrolled onto the Group for Research on Adult Acute Lymphoblastic Leukemia 2003 protocol , which included several pediatric options . Some adult options , such as allogeneic stem-cell transplantation for patients with high-risk ALL , were nevertheless retained . RESULTS were retrospectively compared with the historical France-Belgium Group for Lymphoblastic Acute Leukemia in Adults 94 ( LALA-94 ) trial experience in 712 patients age 15 to 55 years . Results Complete remission rate was 93.5 % . At 42 months , event-free survival ( EFS ) and overall survival ( OS ) rates were 55 % ( 95 % CI , 48 % to 52 % ) and 60 % ( 95 % CI , 53 % to 66 % ) , respectively . Age remained an important bad prognostic factor , with 45 years of age as best cutoff . In older versus younger patients , there was a higher cumulative incidence of chemotherapy-related deaths ( 23 % v 5 % , respectively ; P < .001 ) and deaths in first CR ( 22 % v 5 % , respectively ; P < .001 ) , whereas the incidence of relapse remained stable ( 30 % v 32 % , respectively ) . Complete remission rate ( P = .02 ) , EFS ( P < .001 ) , and OS ( P < .001 ) compared favorably with the previous LALA-94 experience . CONCLUSION These results suggest that pediatric-inspired therapy markedly improves the outcome of adult patients with ALL , at least until the age of 45 years Background . Scant data are available on event‐free survival ( EFS ) for young adults with leukemia who were 16‐21 years of age at diagnosis . In acute lymphoblastic leukemia ( ALL ) , it is well recognized that children have a better EFS compared with adults , whereas for acute myelecytic leukemia ( AML ) , EFS results seem to be similar . To determine the appropriate treatment for young adults with leukemia , outcome data are essential BACKGROUND Adolescents with acute lymphoblastic leukaemia ( ALL ) have languished in the shadow of success of the outcome of therapy in childhood ALL . Their treatment has always been incorporated into either paediatric or adult clinical trials depending on the mode of referral and hence there is a need to address an age and risk specific strategy for improving the outcome of this neglected group of patients . This article has summarised the recent and up date d retrospective comparative analysis of adolescents treated on the Medical Research Council ( MRC ) trials . This analysis adds further emphasis to the treatment approach and the merits and limitations of treatment of adolescents on paediatric and adult trials . METHODS A retrospective comparative analysis of adolescents aged 15 - 17 years , treated on either MRC ALL97/revised 99 ( n = 61 ) , a r and omised paediatric trial or UKALLXII/E2993 ( n = 67 ) , an adult trial , between 1997 and 2002 was undertaken . RESULT Results suggest a trend towards a superior outcome on paediatric trials . The 5-year EFS on ALL97 was 65 % ( 95 % CI = 52 - 78 % ) and on UKALLXII/E2993 was 49 % ( 95 % CI = 37 - 61 % ; P = 0.01 ) . Multivariate analysis allowing for age and Ph status , diminished the EFS difference , but confirmed a reduced rate of death in remission in patients managed on the paediatric protocol . CONCLUSIONS Despite limitations in the methodology , comparative studies including our MRC study suggest a consistent advantage for adolescents managed intensively on paediatric trials . Redefining age limits with risk-based strategy and multi-centre collaboration should be considered to improve the survival of young adults Background : Between January 1989 and July 1995 , a prospect i ve study of the therapeutic efficacy of the LALA 87 protocol in adult acute lymphoblastic leukaemia ( ALL ) has been conducted . Methods : A total of hundred and twelve patients with ALL have been analysed . The median age of the patients was 40 years ( range : 15–65 ) , the gender ratio ( M/F ) was 66/46 , and the morphologic FAB ( French-American-British ) profile was L1 in 30 ( 26.9 % ) patients , L2 in 71 ( 63.3 % ) and L3 morphology in 11 ( 9.8 % ) of the patients . The LALA 87 protocol includes five phases : induction , consolidation , reinforcement , maintenance and central nervous system ( CNS ) prophylaxis with intrathecal methotrexate and irradiation . The induction phase comprised daunorubicin 50 mg/m2 ( days 1–3 ) , cyclophosphamide 600 mg/m2 ( days 1 and 8) , vincristine 1.5 mg/m2 ( on days 1 , 8 , 15 and 22 ) and daily oral prednisone on days 1–21 . Maintenance therapy was given for 2 years and consisted of different drugs as reinforcement , daily 6-mercaptopurine and weekly methotrexate . Results : Complete remission ( CR ) was achieved in 81 ( 72.3 % ) of the patients . The causes of induction failure were partial response in 10 ( 8.9 % ) , and hypoplastic death in 12 patients ( 10.7 % ) , and 9 were non-responders ( 8.0 % ) . Of the 81 patients who achieved CR , 62 relapsed ( 76 % ) . Among the relapsed patients , 9 developed CNS disease in spite of CNS prophylaxis during induction chemotherapy . Median follow-up for the living patients was 110 months . Median disease-free survival ( DFS ) was 
    Output:
    
Pediatric-inspired regimens are superior to conventional-adult chemotherapy in AYA ALL patients .