Abstract
Introduction: Treatment of acute lymphoblastic leukemia (ALL) generally includes multi-agent chemotherapy. The regimens used at our institution include: HyperCVAD with or without rituximab (R), CALGB 10403, CALGB 19802 and CALGB 8811. All of these regimens include an induction backbone of vincristine, anthracycline, and corticosteroid. Additionally, all regimens, with the exception of HyperCVAD/R-HyperCVAD, include an asparaginase product. At the current time, treatment choice for adult ALL patients has been provider specific and there is no data to suggest one regimen is better than another, as rates of complete remission and 5 year overall survival are similar.
Purpose: The purpose of this study was to determine whether choice of induction therapy between asparaginase and non-asparaginase containing regimens had an impact on the rate of residual disease positivity in adult ALL patients treated at a large academic medical center.
Patients and Methods: We conducted a single-center, retrospective cohort study of 66 consecutive adult patients with a diagnosis of ALL between January 2002 and October 2016 treated at our center. Data collected on study subjects included: demographics, ALL subtype, chemotherapy regimen, toxicities, treatment delays, treatment dose reductions, cytogenetic disease risk category, and residual disease positivity by flow cytometry after first induction therapy. First induction was defined as the first cycle or course of the chemotherapy framework. Descriptive statistics were used to summarize the sample. Association of post-induction residual disease positivity and adverse effects were examined using Chi-squared tests.
Results: The median follow up of survivors for the study was 38 months. Induction treatment with an asparaginase-containing regimen was associated with a lower rate of residual disease post-induction when compared to treatment with non-asparaginase containing regimens (36.8% vs 12.8%; p=0.0260). There was no statistically significant difference found in one-year mortality, two-year mortality, treatment for neuropathy, and rate of relapse between asparaginase and non-asparaginase containing regimens.
Conclusion: Adult ALL patients treated with asparaginase-containing regimens have lower rates of residual disease analyzed by flow cytometry after induction; however, this is not translated into a difference in overall survival.
Rizzieri: Erytech: Research Funding; Shire: Research Funding.
