Comparison of a modified pediatric protocol versus a hyper-CVAD protocol in adolescents and young adults with Philadelphia-negative acute lymphoblastic leukemia: A multicenter retrospective analysis.

Abstract

BACKGROUND:

The outcomes of Pediatric acute lymphoblastic leukemia (ALL) have improved dramatically whereas outcomes for ALL amongst adolescents and young adults (AYA) have lagged behind. The introduction of pediatric-like regimens to manage adult ALL has shown promising outcomes across several analyses.

MATERIALS AND METHODS:

In this analysis, we aimed to retrospectively compare the differences in outcomes among patients aged 14-40 years with Philadelphia-negative ALL treated with a Hyper-CVAD protocol versus a modified pediatric protocol.

RESULTS:

A total of 103 patients were identified with 58 (56.3%) in the modified ABFM group and 45 (43.7%) in the hyper-CVAD group. The median duration of follow-up for the cohort was 39 months (range 1-93). There were significantly lower rates of MRD persistence after consolidation (10.3% vs. 26.7%, P = 0.031) and transplantation (15.5% vs. 46.6%, P < 0.001) in the modified ABFM group. 5-year OS rates (83.9% vs. 65.3%, P = 0.036) and DFS rates (67.4% vs. 44%, P = 0.014) were higher in the modified ABFM groups. The incidence of grade 3 and 4 hepatotoxicity (24.1% vs. 13.3%, P < 0.001) and osteonecrosis (20.6% vs. 2.2%, P = 0.005) were higher in the modified ABFM group.

CONCLUSION:

Our analysis demonstrates that the use of a pediatric modified ABFM protocol demonstrated superior outcomes compared to the hyper-CVAD regimen in the treatment of Philadelphia-negative ALL amongst AYA patients. However, the modified ABFM protocol was associated with an increased risk of certain toxicities including high grade liver toxicity and osteonecrosis.

• Authors: Hind Salama, Saleem Eldadah, Mohamed H Omer, Ayman Alhejazi, Luluh Bin Dayil, Ayman Almozaini, Roaa Reda Khalil, Areej Al Mugairi, Mohammed Snnallah, Moussab Damlaj, Ahmed Alaskar, Ahmad Alsaeed, Mohammed Mosa Bakkar, Bader Alahmari, Mohsen Alzahrani, Ihab Elhemaidi, Majed Alahmadi, Sameer Alamoudi, Walaa Rajkhan, Manar Khalil, Solaf Sami Kanfar, Abdullah S Al Saleh, Abdulrahman Al Raizah, Ayman Ibrahim, Ahmed Absi
• Journal: Leukemia research (Leuk Res) Vol. 130 Pg. 107316 (Jul 2023) ISSN: 1873-5835 [Electronic] England
• PMID: 37245332 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Elsevier Ltd. All rights reserved.

Chemical References

• Doxorubicin
• Cyclophosphamide
• Dexamethasone
• Vincristine

Topics

• Humans
• Adolescent
• Young Adult
• Child
• Retrospective Studies
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, complications)
• Doxorubicin (therapeutic use)
• Cyclophosphamide (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Dexamethasone (adverse effects)
• Vincristine (therapeutic use)
• Multicenter Studies as Topic