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The Dana Farber consortium protocol (DFCP) vs. classic Hyper-CVAD for treatment of acute lymphoblastic leukemia in
Amal S Alabdulwahab1, Hussein G Elsayed1, Mohamed A Sherisher2
1Hematology Department, King Abdullah Medical City- HC, Saudi Arabia.
Insights
Pediatric intensive protocols for acute lymphoblastic leukemia (ALL) show promise in adults under 50. DFCP demonstrated superior 3-year overall survival compared to Hyper-CVAD, suggesting potential benefits for older ALL patients.
Area of Science:
- Hematology
- Oncology
- Clinical Trials
Background:
- Intensive pediatric protocols for acute lymphoblastic leukemia (ALL) are increasingly applied to adult patients.
- This study evaluates the extension of these protocols to older adult populations.
Purpose of the Study:
- To compare the efficacy and toxicity of the pediatric DFCP protocol versus the classic Hyper-CVAD protocol in adult patients (<50 years) with ALL.
- To assess outcomes including complete remission, leukemia-free survival, and overall survival.
Main Methods:
- A retrospective, single-center comparative analysis was conducted.
- 73 patients with ALL under 50 years were included, with 43 receiving DFCP and 30 receiving Hyper-CVAD as first-line treatment.
Main Results:
- Complete remission rates were 90.7% for DFCP and 83.7% for Hyper-CVAD (p=0.7).
- Three-year overall survival was significantly higher with DFCP (72.6%) compared to Hyper-CVAD (48.5%) (p=0.04).
- Younger patients (<21 years) showed significantly longer leukemia-free and overall survival.
Conclusions:
- Pediatric protocols, such as DFCP, are feasible and potentially more active than classic adult protocols for ALL patients under 50.
- Further investigation in randomized controlled trials is needed to confirm the benefits of modified adult protocols.
Background:
The use of intensive pediatric protocols for the treatment of ALL is being extended to older adults.
Aim Of The Study:
Analysis of the efficacy and toxicity results of pediatric DFCP vs. classic Hyper-CVAD protocol for the treatment of patients with ALL < 50 Y.
Patients And Methods:
A retrospective single center comparative analysis of DFCP & classic Hyper-CVAD for first line treatment of patients with ALL < 50 Y.
Results:
73 patients were included, 43 received DFCP and 30 received Hyper-CVAD protocol. CR rate was 90.7% for DFCP vs. 83.7 for Hyper-CVAD (p 0.7). 3 Y Leukemia free survival was 57.4% (70.9% for DFCP vs. 41.6% Hyper-CVAD P 0.1) while 3Y OS was 62.6%% for the whole group, 72.6% DFCP vs. 48.5% Hyper-CVAD, P 0.04. Those with age <21 Y, had significantly longer 3 Y LFS and OS (P 0.04, 0.02, respectively).
Toxicity:
pancreatitis occurred in 5 patients with DFCP and it was related to Asparginase and in 1 patient on Hyper-CVAD related to gall stones. Osteonecrosis affected 5 patients on DFCP.
In Conclusion:
pediatric protocols are feasible in patients younger than 50 Y and they are more active than classic adult protocols. Although modifications of adult protocols may improve their results, this had to be investigated in randomized controlled trials.
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