Comparison of a modified pediatric protocol versus a hyper-CVAD protocol in adolescents and young adults with Philadelphia-negative acute lymphoblastic leukemia: a multicenter retrospective analysis

Salama, Hind, Eldadah, Saleem, Omer, Mohamed ORCID: https://orcid.org/0000-0001-5967-9984, Hejazi, Ayman, Bin Dayil, Luluh, Almozaini, Ayman, Khalil, Roaa Reda, Mugairi, Areej Al, Snnallah, Mohammed, Damlaj, Moussab, Alaskar, Ahmed, Alsaeed, Ahmad, Bakkar, Mohammed Mosa, Alahmari, Bader, Alzahrani, Mohsen, Elhemaidi, Ihab, Alahmadi, Majed, Alamoudi, Sameer, Rajkhan, Walaa, Khalil, Manar, Kanfar, Solaf Sami, Saleh, Abdullah S. Al, Raizah, Abdulrahman Al, Ibrahim, Ayman and Absi, Ahmed 2023. Comparison of a modified pediatric protocol versus a hyper-CVAD protocol in adolescents and young adults with Philadelphia-negative acute lymphoblastic leukemia: a multicenter retrospective analysis. Leukemia Research 130 , 107316. 10.1016/j.leukres.2023.107316 Item availability restricted.

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Abstract

Background The outcomes of Pediatric acute lymphoblastic leukemia (ALL) have improved dramatically whereas outcomes for ALL amongst adolescents and young adults (AYA) have lagged behind. The introduction of pediatric-like regimens to manage adult ALL has shown promising outcomes across several analyses. Materials and Methods In this analysis, we aimed to retrospectively compare the differences in outcomes among patients aged 14-40 years with Philadelphia-negative ALL treated with a Hyper-CVAD protocol versus a modified pediatric protocol. Results A total of 103 patients were identified with 58 (56.3%) in the modified ABFM group and 45 (43.7%) in the hyper-CVAD group. The median duration of follow-up for the cohort was 39 months (range 1-93). There were significantly lower rates of MRD persistence after consolidation (10.3% vs. 26.7%, P=0.031) and transplantation (15.5% vs. 46.6%, P<0.001) in the modified ABFM group. 5-year OS rates (83.9% vs. 65.3%, P=0.036) and DFS rates (67.4% vs. 44%, P=0.014) were higher in the modified ABFM groups. The incidence of grade 3 and 4 hepatotoxicity (24.1% vs. 13.3%, P<0.001) and osteonecrosis (20.6% vs. 2.2%, P=0.005) were higher in the modified ABFM group. Conclusion Our analysis demonstrates that the use of a pediatric modified ABFM protocol demonstrated superior outcomes compared to the hyper-CVAD regimen in the treatment of Philadelphia-negative ALL amongst AYA patients. However, the modified ABFM protocol was associated with an increased risk of certain toxicities including high grade liver toxicity and osteonecrosis. Data Availability Statement The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	License information from Publisher: LICENSE 1: Title: This article is under embargo with an end date yet to be finalised.
Publisher:	Elsevier
ISSN:	0145-2126
Date of First Compliant Deposit:	23 May 2023
Date of Acceptance:	19 May 2023
Last Modified:	23 Nov 2023 20:26
URI:	https://orca.cardiff.ac.uk/id/eprint/159894

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