Updated risk-oriented strategy for acute lymphoblastic leukemia in adult patients 18–65 years: NILG ALL 10/07: Blood Cancer Journal

R. Bassan, C. Pavoni, T. Intermesoli, O. Spinelli, M. Tosi, E. Audisio, F. Marmont, C. Cattaneo, E. Borlenghi, S. Cortelazzo, I. Cavattoni, M. Fumagalli, D. Mattei, C. Romani, A. Cortelezzi, N. Fracchiolla, F. Ciceri, M. Bernardi, A.M. Scattolin, L. DepaoliA. Masciulli, E. Oldani, A. Rambaldi

Research output: Contribution to journalArticlepeer-review

Abstract

An updated strategy combining pediatric-based chemotherapy with risk-oriented allogeneic hematopoietic cell transplantation (HCT) was evaluated in Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph− ALL) and compared with a published control series. Following induction–consolidation chemotherapy, responsive patients were assigned to receive maintenance chemotherapy or undergo early HCT according to the risk stratification criteria and minimal residual disease (MRD) status. Of the 203 study patients (median age 41 years, range 17–67), 140/161 with Ph− ALL achieved complete remission (86.9%; 91.6% ≤55 years, P = 0.0002), with complete MRD clearing in 68/109; 55 patients were assigned to maintenance chemotherapy, and 85 to HCT due to very high-risk characteristics (hyperleukocytosis, adverse genetics, early/mature T-precursor ALL, and MRD persistence). The 5-year relapse incidence was 36%, and the treatment-related mortality rate was 18%. Median overall and relapse-free survival were 7.4 and 6.2 years, with rates of 54 and 53% at 5 years, respectively, which were significantly better than those obtained with the historical protocol (P = 0.001 and P = 0.005, respectively), without significant differences between maintenance and HCT cohorts. In prognostic analysis, MRD negativity and age ≤55 years were the most favorable independent prognostic factors. A reduction in treatment toxicity and further improvements in the risk definitions and risk-oriented design are the focuses of this ongoing research. © 2020, The Author(s).
Original languageEnglish
JournalBlood Cancer J.
Volume10
Issue number11
DOIs
Publication statusPublished - 2020

Keywords

  • asparaginase
  • cyclophosphamide
  • cytarabine
  • dexamethasone
  • folinic acid
  • idarubicin
  • imatinib
  • melphalan
  • mercaptopurine
  • methotrexate
  • prednisone
  • vincristine
  • acute lymphoblastic leukemia
  • adolescent
  • adult
  • aged
  • allogeneic hematopoietic stem cell transplantation
  • Article
  • brain hemorrhage
  • cancer incidence
  • cancer prognosis
  • cancer risk
  • cohort analysis
  • consolidation chemotherapy
  • controlled study
  • drug dose reduction
  • drug efficacy
  • drug megadose
  • drug safety
  • drug tolerability
  • event free survival
  • female
  • follow up
  • human
  • human cell
  • induction chemotherapy
  • infectious complication
  • maintenance chemotherapy
  • major clinical study
  • male
  • minimal residual disease
  • molecular probe
  • mortality rate
  • overall survival
  • pancytopenia
  • Philadelphia chromosome negative cell
  • pneumonia
  • recurrence free survival
  • remission

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