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

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.

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.