Comparing Outcomes of First-Line Intensive Chemotherapeutic Regimens in Adult Patients With Acute Lymphoblastic Leukemia at a Tertiary Center.

IF 2.7 4区 医学 Q2 HEMATOLOGY
Ahmed Mohamed, Emily C Zabor, Meera Patel, Hadil Zureigat, Moath Albliwi, Mark Jinan Chen, Joy Nakitandwe, David S Bosler, Heena Kurish, Akriti G Jain, John C Molina, Sophia Balderman, Abhay Singh, Aaron T Gerds, Sudipto Mukherjee, Hetty E Carraway, Anjali S Advani, Moaath K Mustafa Ali
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引用次数: 0

Abstract

Background: Survival outcomes of acute lymphoblastic leukemia (ALL) in adults remain inferior to those in the pediatric population. Limited data is present directly comparing different first-line intensive regimens in adult patients with ALL.

Methods: We conducted a retrospective study comparing outcomes of first-line intensive chemotherapeutic regimens utilized in adult ALL patients at Cleveland Clinic. Outcomes included composite complete response (CCR), minimal residual disease (MRD) flow cytometry (FC-MRD) response, overall survival (OS) and event-free survival (EFS). Multivariable regression and propensity score (PS) weighting were used for adjustment.

Results: Out of 161 adult patients with ALL between January, 2017 and August, 2023, 100 received an intensive regimen. Of those, 33% (n = 33) received a pediatric-inspired regimen (PIR) (CALGB-10403, n = 32 (97%)), 39% (n = 39) received CALGB-19802, and 28% (n = 28) received Hyper-CVAD. The median age (IQR) was 27 (21-34) for PIR group, 59 (52-65) years for CALGB-19802 group, and 57 (41-66) years for Hyper-CVAD group. The CCR rates were 88%, 82%, and 81% in PIR, CALGB-19802, and Hyper-CVAD groups. The 3-year OS was 78% (95% CI, 63-95), 58% (95% CI, 44-77), and 70% (95% CI, 52-93) (P = .2) in the above groups, respectively. Hyper-CVAD was associated with a higher odds of FC-MRD negative response to CALGB-19802 (PS-adjusted odds ratio: 3.72, 95% CI, 1.05-14.7, P = .041). The 3-year PS-adjusted OS in Hyper-CVAD was 71% (95% CI, 52-97) compared to 49% (95% CI, 33-73) in CALGB-19802 (P = .14).

Conclusions: Compared to an asparaginase-utilizing regimen, CALGB-19802, Hyper-CVAD was associated with higher FC-MRD negative responses. The long-term survival outcomes for patients receiving PIR in young individuals were comparable to those of Hyper-CVAD. Future combination therapies involving blinatumomab and inotuzumab ozogamicin are expected to enhance these outcomes.

三级中心急性淋巴细胞白血病成年患者一线强化化疗方案的疗效比较
背景:成人急性淋巴细胞白血病(ALL)的生存结局仍然低于儿童人群。目前对成年ALL患者不同一线强化治疗方案的直接比较数据有限。方法:我们进行了一项回顾性研究,比较了克利夫兰诊所用于成人ALL患者的一线强化化疗方案的结果。结果包括复合完全缓解(CCR)、最小残留病(MRD)、流式细胞术(FC-MRD)反应、总生存期(OS)和无事件生存期(EFS)。采用多变量回归和倾向评分(PS)加权进行调整。结果:在2017年1月至2023年8月期间,161名成年ALL患者中,有100人接受了强化治疗。其中,33% (n = 33)接受了儿科启发方案(PIR) (CALGB-10403, n = 32 (97%)), 39% (n = 39)接受了CALGB-19802, 28% (n = 28)接受了Hyper-CVAD。PIR组的中位年龄(IQR)为27(21-34)岁,CALGB-19802组为59(52-65)岁,Hyper-CVAD组为57(41-66)岁。PIR组、CALGB-19802组和Hyper-CVAD组的CCR分别为88%、82%和81%。3年OS分别为78% (95% CI, 63-95)、58% (95% CI, 44-77)和70% (95% CI, 52-93) (P = .2)。Hyper-CVAD与CALGB-19802的FC-MRD阴性反应的较高几率相关(ps校正优势比:3.72,95% CI, 1.05-14.7, P = 0.041)。Hyper-CVAD的3年ps调整OS为71% (95% CI, 52-97),而CALGB-19802的3年OS为49% (95% CI, 33-73) (P = 0.14)。结论:与使用天冬酰胺酶的CALGB-19802方案相比,Hyper-CVAD与更高的FC-MRD阴性反应相关。接受PIR治疗的年轻患者的长期生存结果与Hyper-CVAD患者相当。未来的联合治疗包括blinatumomab和inotuzumab ozogamicin有望提高这些结果。
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来源期刊
CiteScore
2.70
自引率
3.70%
发文量
1606
审稿时长
26 days
期刊介绍: Clinical Lymphoma, Myeloma & Leukemia is a peer-reviewed monthly journal that publishes original articles describing various aspects of clinical and translational research of lymphoma, myeloma and leukemia. Clinical Lymphoma, Myeloma & Leukemia is devoted to articles on detection, diagnosis, prevention, and treatment of lymphoma, myeloma, leukemia and related disorders including macroglobulinemia, amyloidosis, and plasma-cell dyscrasias. The main emphasis is on recent scientific developments in all areas related to lymphoma, myeloma and leukemia. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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