Comparison of Two Pediatric-Inspired Regimens to Hyper-CVAD in Hispanic Adolescents and Young Adults With Acute Lymphoblastic Leukemia |
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| Authors: | Emmanuel Almanza-Huante Karla Espinosa-Bautista Juan Rangel-Patiño Roberta Demichelis-Gómez |
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| Institution: | 1. Department of Hematology, Instituto Nacional de Cancerología, Mexico City, Mexico;2. Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, “Salvador Zubirán”, Mexico City, Mexico;1. Hematology/Oncology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS;2. Department of Pathology, Keesler Medical Center, Keesler Air Force Base, Biloxi, MS;3. United States Army Institute of Surgical Research, Uniformed Services University, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX;1. Department of Haematology, All India Institute of Medical Sciences, New Delhi, India;2. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India;3. Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India;4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India;1. Department of Oncology, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia;2. King Saud bin Abdul-Aziz University for Health Science, College of Medicine, Riyadh, Saudi Arabia;3. Section of Adult Hematology and Hematopoietic Stem Cell Transplant, Princess Nora Oncology Centre, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia;4. Departments of Pathology and Clinical Laboratory, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia;5. Department of Clinical Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia;6. Section of Adult Hematology and Stem Cell Transplant, Department of Oncology, King Faisal Specialist and Research Centre, Riyadh, Saudi Arabia;7. Bone Marrow Transplantation Program, Department of Internal Medicine American University of Beirut, Medical Center, Beirut, Lebanon;8. Department of Hematology, Fedail Hospital, Khartoum, Sudan;9. Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL;1. The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China;2. The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China;3. University of Chinese Academy of Sciences, Beijing, China;4. The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China;1. Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France;2. Department of Pathology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, INSERM UMR-S 955, Université Paris Est Créteil, Creteil, France;3. Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France;4. Department of Pharmacy, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France;5. Department of Nuclear Medicine, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France |
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| Abstract: | BackgroundPediatric-inspired regimens (PIR) in adolescents and young adults with acute lymphoblastic leukemia have led to better long-term outcomes. In Latin America, the adolescent and young adult population has an increasing incidence of acute lymphoblastic leukemia with poor outcomes (5-year OS of approximately 20%) with traditional regimens.Patients and MethodsA retrospective cohort study was performed of adolescent and young adult acute lymphoblastic leukemia patients treated with PIR in two reference centers in Mexico City between March 2016 and June 2019, in which the primary endpoint was OS, compared to a historic cohort of patients treated with hyper-CVAD treated between February 2009 and June 2015.ResultsWe compared 73 patients treated with PIR (46 and 27 received modified versions of the ALL-BFM 90 and CALGB C10403 regimens, respectively) and 173 patients treated with hyper-CVAD. Patients treated with PIR experienced higher 4-week complete response rates (79.5% vs. 64.2%; P = .02) and lower relapse rates (44.1% vs. 60.0%; P = .04). OS was significantly higher with PIR than with hyper-CVAD (24 months: 41.5% vs. 28.1%; P = .012). The benefit on OS for PIR was only significant for CALGB (24-month OS: 61.1% vs. 28.0%; P = .01) but not for BFM. In the multivariate analysis, hyperleukocytosis (hazard ratio HR] = 1.90; 95% confidence interval CI], 1.11-3.22; P = .02), autologous stem-cell transplantation (HR = 0.38; 95% CI, 0.17-0.86; P = .02), and 4-week complete response (HR = 0.43; 95% CI, 0.26-0.70; P < .01) were independent prognostic factors. For the group of patients older than 20 years, only CALGB had an independent prognostic factor for OS (HR = 0.44; 95% CI, 0.20-0.97; P = .04).ConclusionIn terms of 4-week complete response, relapse rates, and OS, PIR provides benefits to Hispanic patients. |
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| Keywords: | Acute lymphoblastic leukemia Adolescents and young adults Latin America Pediatric-inspired regimens |
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