Hyper‐CVAD plus nelarabine in newly diagnosed adult T‐cell acute lymphoblastic leukemia and T‐lymphoblastic lymphoma |
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| Authors: | Yasmin Abaza Hagop M. Kantarjian Stefan Faderl Elias Jabbour Nitin Jain Deborah Thomas Tapan Kadia Gautam Borthakur Joseph D. Khoury Jan Burger William Wierda Susan O'Brien Marina Konopleva Alessandra Ferrajoli Partow Kebriaei Bouthaina Dabaja Steven Kornblau Yesid Alvarado Naval Daver Naveen Pemmaraju Prithviraj Bose Philip Thompson Hind Al Azzawi Mary Kelly RN Rebecca Garris Preetesh Jain Guillermo Garcia‐Manero Jorge Cortes Farhad Ravandi |
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| Affiliation: | 1. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas;2. Department of Hematology/Oncology, Hackensack University Medical Center, Hackensack, New Jersey;3. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas;4. Department of Hematology/Oncology, University of California, Irvine, California;5. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas;6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas |
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| Abstract: | Nelarabine, a water soluble prodrug of 9‐β‐D‐arabinofuranosylguanine (ara‐G), is a T‐cell specific purine nucleoside analogue. Given its activity in relapsed and refractory T acute lymphoblastic leukemia (T‐ALL) and T lymphoblastic lymphoma (T‐LBL), we sought to define its role in the frontline treatment of adult patients. Therefore, we conducted a single arm phase 2 study to determine the safety and efficacy of nelarabine in combination with hyper‐CVAD in newly diagnosed patients. For induction/consolidation, patients received eight cycles of hyper‐CVAD alternating with high‐dose methotrexate and cytarabine plus two cycles of nelarabine given at a dose of 650 mg/m2 intravenously daily for 5 days. This was followed by thirty months of POMP maintenance chemotherapy with two additional cycles of nelarabine given instead of cycles 6 and 7 of POMP maintenance. Sixty‐seven patients, including 40 with T‐ALL and 26 with T‐LBL, were enrolled. Complete response rates in both T‐ALL and T‐LBL were 87% and 100% respectively. Grade 3 to 4 neurotoxic adverse events were reported in 5 patients. There were 21 relapses (31%) including 2 after allogeneic stem cell transplantation. Median duration of follow‐up was 42.5 months. The 3‐year complete remission duration (CRD) and overall survival (OS) rates were 66% and 65%, respectively. Compared to our historic hyper‐CVAD data, there was no survival benefit with the addition of nelarabine. In conclusion, hyper‐CVAD plus nelarabine was well tolerated and active in the frontline treatment of adult T‐ALL/LBL patients. |
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