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Hyper-CVAD and Modified CALGB-10403 Regimens in Adult Patients With Philadelphia-Negative Acute Lymphoblastic
Jessica Zalapa-Soto1, Fausto Alfredo Rios-Olais1, Lyam Carlo Chacón-Rangel1
1Hematology and Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Objective:
Acute lymphoblastic leukemia (ALL) has a higher incidence in Latin America, with adult patients experiencing worse long-term outcomes despite high complete remission (CR) rates. When treated with adult regimens, 3-year overall survival (OS) is approximately 20%. However, adopting pediatric-inspired regimens (PIRs) has shown improved outcomes.
Methods:
We performed a comparative analysis of Hispanic adult patients with newly diagnosed Ph-negative ALL, treated with either a PIR, a modified CALGB 10403 (mCALGB), or the adult regimen Hyper-CVAD between January 2015 and May 2023. The primary endpoint was OS and among secondary endpoints relapse-free survival (RFS).
Results:
We included 100 patients, 35 were treated with Hyper-CVAD and 65 with mCALGB. Median age was 26 years (range, 20.2-38). The median OS was 54.2 months (95% CI 28.3-80.1), with a non-reached median OS in the mCALGB group (95% CI NR-NR) versus 22.4 months (95% CI 13.7-31) for Hyper-CVAD. The 3-year OS was 64.9% versus 34.9%, p = 0.034. Treatment with mCALGB was independently associated with OS (HR 0.29, 95% CI 0.13-0.66, p = 0.003) and RFS (HR 0.29, 95% CI 0.14-0.59, p < 0.001).
Conclusions:
Treatment with mCALGB was independently associated with benefits regarding RFS and OS when compared to Hyper-CVAD.
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