Regimens confer comparable OS among adolescents, young adults with ALL
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Pediatric-inspired protocols and hyper-CVAD conferred comparable survival for adolescents and young adults with Philadelphia chromosome-negative acute lymphoblastic leukemia, according to study results.
Patients treated with pediatric-inspired protocols achieved higher rates of 2-year EFS and RFS, findings presented at Society of Hematologic Oncology Annual Meeting showed.
However, researchers reported no difference in OS between treatment approaches.
ALL survival rates for adolescents and young adults (AYAs) — those aged 15 to 39 years — are higher than those for adults but lower than those for children, according to study background.
This has led research groups to assess whether pediatric-inspired regimens — which are more intensive and highly regimented than those used for adults — may improve outcomes among AUAs.
Prior retrospective studies conducted in the United States and Europe showed AYAs with ALL achieved considerably better outcomes when treated with pediatric-inspired protocols; however, other studies showed no significant benefit.
Omar Shahin, MD, medical oncologist at King Hussein Cancer Center in Jordan, and colleagues aimed to assess outcomes of AYAs with Philadelphia chromosome-negative ALL treated with pediatric-inspired protocols vs. those treated with fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (hyper-CVAD).
OS, EFS and RFS served as primary outcomes. Secondary outcomes included complete remission rates at the end of induction, rates of leukemia relapse, presence of extramedullary disease at relapse and rates of allogeneic stem cell transplantation.
Researchers reviewed medical records of 113 AYAs (age range, 18 to 40 years) with Philadelphia chromosome-negative ALL treated at King Hussein Cancer Center from 2010 to 2022.
Half (50.5%) received hyper-CVAD and half (49.5%) received treatment per pediatric-inspired protocols. Pediatric-inspired protocols included the CALGB 10403 regimen, the augmented BFR regimen and the GRAALL-2005 regimen.
Treatment groups appeared balanced with regard to sex, cytogenetics, phenotype and prevalence of high-risk disease.
Investigators reported higher rates of 2-year RFS (93.7% vs. 59.6%; P = .0001; median RFS, not reached vs. 74.2 months) and 2-year EFS (80.6% vs. 52.6%; P = .004; median EFS, not reached vs. 43.7 months) among those treated with pediatric-inspired protocols.
However, results showed no statistically significant difference in 2-year OS between the pediatric-inspired protocol and hyper-CVAD groups (80.3% vs. 65.7%; median OS not reached in either group).
Approximately 93% of patients in each group achieved remission at end of induction.
However, a higher percentage of patients treated with hyper-CVAD relapsed (38.6% vs. 5.6%).
Researchers reported no significant difference in rate of subsequent allogeneic stem cell transplant between the hyper-CVAD and pediatric-inspired protocol groups (28.1% vs. 19.6%).
Ninety patients (80.4%) in the analysis remained in remission at last follow-up. A higher percentage of patients treated with pediatric-inspired protocols remained in remission (89.1% vs. 71.9%; P = .004).
Two patients — both of whom were treated with pediatric-inspired protocols — died during induction. Eleven patients — six (14.6%) treated with hyper-CVAD and five (10.2%) treated with pediatric-inspired protocols — died while in complete remission.
“Prospective trials comparing both adult and pediatric-inspired protocols are warranted,” Shahin said during a presentation.
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Shahin O, et al. Abstract ALL-363. Presented at: Society of Hematologic Oncology Annual Meeting; Sept. 6-9, 2023; Houston.
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