Acute Lymphoblastic Leukemia in Young Adults Treated with Intensive "Pediatric" Type Protocol

Young adults with acute lymphoblastic leukemia do better when treated on "pediatric" protocols. Young adults (18-30 years) with Ph-negative ALL treated between 2000 and 2014 were retrospectively analyzed. Two-hundred and thirty-two patients were included [median age 21 years (18-30); 176 (76%) males; median WBC 16,000/cmm]. Protocols used were: BFM 95 (N = 147, 63%), MCP-841 (N = 51, 22%), GMALL (N = 21, 9%), INCTR (N = 9, 4%) and UKALL (N = 4, 2%). Complete remission was achieved in 194/232 (84%). Twenty patients (9%) died due to toxicity which was higher with BFM versus others (18/147 vs. 2/85; p = 0.031). After a median follow-up of 48 months, median RFS and OS were 35.5 months (25-46), and 25 months (18-31) and actuarial RFS and OS (5-years) were 45% (37-53) and 39% (32-46). BFM protocol improved RFS (51 vs. 35%, p = 0.027) but not OS (43 vs. 33%, p = 0.2). The survival outcomes reported are 15-20% lower than those reported from West. Better supportive care and risk-adapted therapy may improve outcomes.