What is the efficacy of pediatric regimens for the treatment of adults with acute lymphoblastic leukemia (ALL)?

Updated: Jul 17, 2018
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Deangelo et al treated adult patients aged 18-50 years with ALL with the DFCI Pediatric ALL Consortium regimen utilizing a 30-week course of pharmacokinetically dose-adjusted E. coli L-asparaginase during consolidation. Between 2002 and 2008, 92 eligible patients aged 18-50 years were enrolled. Seventy-eight patients (85%) achieved a CR after 1 month of intensive induction therapy. With a median follow-up of 4.5 years, the 4-year disease-free survival for the patients achieving a CR was 69% and the 4-year overall survival for all eligible patients was 67%.

Seftel et al. compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, the incidence of relapse after HCT was 24% versus 23% for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort (37%) versus chemo (6%), P< 0.0001. DFS in the HCT cohort was 40% versus 71% for chemo, P< 0.0001. Similarly, OS favored chemo (HCT 45%) versus chemo (73%), P< 0.0001.

Alabdulwahab et al compared patients < 50 years treated on the Dana Farber consortium protocol (DFCP) vs. classic Hyper-CVAD for treatment of ALL. The CR rate was 90.7% for DFCP vs. 83.7 for hyper-CVAD (P = 0.7). Three-year leukemia-free survival was 70.9% for DFCP vs. 41.6% for hyper-CVAD (P= 0.1), while 3-year OS was 72.6% for DFCP vs. 48.5% for hyper-CVAD (P= 0.04).

However Rytting et al compared the results inof 106 AYA patients (median age 22 years) who received augmented Berlin-Frankfurt-Münster (BFM) to 102 AYA patients (median age 27 years) who received hyper-CVAD. [58]  The CR rate was 93% with augmented BFM and 98% with hyper-CVAD. The 5-year complete remission durations were 53 and 55%, respectively (P = 0.98). The 5-year overall survival rates were 60 and 60%, respectively. Severe regimen toxicities with augmented BFM included hepatotoxicity in 41%, pancreatitis in 11%, osteonecrosis in 9%, and thrombosis in 19%. Myelosuppression-associated complications were most significant with hyper-CVAD.

Randomized trials are needed to confirm any advantage the pediatric-style regimens may have.


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