Higher Survival Advantage with Hyper-CVAD Chemotherapy Regimen Before Allogeneic Stem Cell Transplantation in Patients with High Risk Adult Acute Lymphoblastic Leukemia: Two-Center Experience

Year 2022, , 215 - 220, 30.12.2022

Emrah Kılıçaslan , Selim Sayın , Murat Yıldırım , Tayfun Elibol Hilmi Gözden Meltem Aylı , Muhammet Kaptan

https://doi.org/10.47572/muskutd.930925

Abstract

While promising results have been achieved in the treatment of childhood, the optimal initial treatment for adult acute lymphoblastic leukemia (ALL) has not yet been defined. Hyper-CVAD has become a widely used treatment for approximately 2 decades in the treatment of adult ALL. We conducted a retrospective analysis of 30 patients treated with Hyper-CVAD at two centers between 2014 and 2020. In all (n=30) patients treated with Hyper-CVAD, complete response (CR) rate was 86.7%, induction mortality was 10%, refractory disease was 3.3%, the median overall survival (OS) was 38 months (95% CI 7.78–68.2 months), the median disease-free survival (DFS) was 29 months (95% CI 9–49 months), the 2-year OS rate was 56.5%, and the 2-year DFS was rate 56.7%. For standard risk (n=12) ALL patients, the median OS was 20 months (95% CI 0–43 months), and median DFS was 7 months (95% CI 0–25 months). For high risk (n=18) ALL patients, the median OS was 38 months (95% CI 0–76 months), and median DFS was not reached. These results indicate that Hyper-CVAD regimen should be considered as an option for induction treatment of adult ALL patients who are newly diagnosed and eligible for allo-HSCT.

Keywords

Hyper-CVAD, Acute lymphoblastic leukemia, Adult, Transplantation, Chemotherapy

Supporting Institution

No funding was received for conducting this study

Thanks

Special thanks to Asst. Prof Dr Erdem Çevik, Dr Erman Öztürk and Dr Işıl Özünal.

Yüksek Riskli Yetişkin Akut Lenfoblastik Lösemili Hastalarda Allojenik Kök Hücre Transplantasyonu Öncesi Hiper CVAD Kemoterapi Rejimi ile Daha Yüksek Sağkalım Avantajı: İki Merkez Deneyimi

Abstract

Çocukluk çağı akut lenfoblastik lösemi (ALL) tedavisinde umut verici sonuçlar elde edilirken, yetişkin için optimal indüksiyon tedavisi henüz belirlenememiştir. Hyper-CVAD kemoterapi rejimi, yetişkin ALL tedavisinde yaklaşık yirmi yıldır yaygın olarak kullanılan bir tedavi haline gelmiştir. 2014 ve 2020 yılları arasında iki merkezde Hyper-CVAD rejimi ile tedavi edilen 30 hastanın retrospektif analizini gerçekleştirdik. Hyper-CVAD ile tedavi edilen hastalarda (n=30), tam yanıt oranı (TY) %86.7, indüksiyon mortalitesi %10, refrakter hastalık %3.3, medyan genel sağkalım (GS) 38 ay (%95 CI 7.78-68.2 ay), medyan hastalıksız sağkalım (HS) 29 ay (% 95 CI 9-49 ay), 2 yıllık GS oranı % 56.5 ve 2 yıllık HS oranı % 56.7 olarak saptadık. Standart risk (n=12) ALL hastalar için, medyan GS 20 ay (%95 CI 0-43 ay) ve medyan HS 7 ay (%95 CI 0-25 ay) saptadık. Yüksek riskli (n=18) ALL hastalar için, medyan GS 38 ay iken (%95 CI 0-76 ay), medyan HS’a ulaşılamadı. Bu sonuçlar, Hyper-CVAD rejiminin yeni tanı konmuş ve allojenik kök hücre transplantasyonu için uygun olan ALL hastalarının indüksiyon tedavisi için bir seçenek olarak değerlendirilmesi gerektiğini göstermektedir.

Keywords

Hyper-CVAD, Akut lenfoblastik lösemi, Yetişkin, Transplantasyon, Kemoterapi

References

• 1. Copelan EA, McGuire EA. The biology and treatment of acute lymphoblastic leukemia in adults. Blood. 1995;85(5):1151-68.
• 2. Kantarjian HM, O'Brien S, Smith TL, et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol. 2000;18(3):547-61.
• 3. Kantarjian H, Thomas D, O'Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. 2004;101(12):2788-801.
• 4. Goldstone AH, Richards SM, Lazarus HM, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). 2008;111(4):1827-33.
• 5. Hutchison RE, Murphy SB, Fairclough DL, et al. Diffuse small noncleaved cell lymphoma in children, Burkitt's versus non-Burkitt's types. Results from the Pediatric Oncology Group and St. Jude Children's Research Hospital. Cancer. 1989;64(1):23-8.
• 6. Xu W, Li JY, Qian SX, et al. Outcome of treatment with Hyper-CVAD regimen in Chinese patients with acute lymphocytic leukemia. Leukemia Res. 2008;32(6):930-5.
• 7. Buyukasik Y, Acar K, Kelkitli E, et al. Hyper-CVAD regimen in routine management of adult acute lymphoblastic leukemia: a retrospective multicenter study. Acta Haematol. 2013;130(3):199-205.
• 8. Erkut N, Akidan O, Batur DS, et al. Comparison between Hyper-CVAD and PETHEMA ALL-93 in adult acute lymphoblastic leukemia: a single-center study. Chemotherapy. 2018;63(4):207-13.
• 9. Morris K, Weston H, Mollee P, et al. Outcome of treatment of adult acute lymphoblastic leukemia with hyperfractionated cyclophosphamide, doxorubicin, vincristine, dexamethasone/methotrexate, cytarabine: results from an Australian population. Leuk Lymphoma. 2011;52(1):85-91.