Paediatric-inspired regimen reduces central nervous system relapse in adult acute lymphoblastic leukaemia
Haimei Liang1,2, Bailin He1,2, Junjie Chen1,2
1Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Insights
A paediatric-inspired chemotherapy regimen significantly reduced central nervous system (CNS) relapse in adult acute lymphoblastic leukaemia (ALL) patients compared to standard adult regimens. This finding offers a promising strategy for improving outcomes in ALL patients experiencing CNS recurrence.
Area of Science:
- Oncology
- Hematology
- Clinical Trials
Background:
- Central nervous system (CNS) relapse is a significant challenge in adult acute lymphoblastic leukaemia (ALL), often leading to poor patient outcomes.
- Extramedullary relapse, particularly in the CNS, is a common and concerning event in adult ALL patients.
Purpose of the Study:
- To evaluate the efficacy of a paediatric-inspired chemotherapy regimen in reducing CNS relapse in adult ALL patients.
- To compare the rate of CNS relapse between adult patients treated with a standard adult regimen versus a paediatric-inspired regimen.
Main Methods:
- A cohort of 1005 newly diagnosed adult ALL patients was analyzed.
- Patients received either the Hyper-CVAD adult regimen (n=596) or the PDT-ALL-2016 paediatric-inspired regimen (n=409).
- The 5-year cumulative incidence of CNS relapse was compared between the two treatment groups.
Main Results:
- The paediatric-inspired regimen group showed a lower CNS relapse rate (7.09%) compared to the adult regimen group (11.24%).
- This difference was statistically significant (p=0.025).
- Even in high-risk patients, the paediatric-inspired regimen demonstrated a significantly lower 5-year cumulative CNS relapse incidence (6.75% vs. 13.7%, p=0.003).
Conclusions:
- Paediatric-inspired chemotherapy regimens may be a protective factor against CNS relapse in adult ALL.
- These findings suggest that adapting paediatric protocols could improve outcomes for adult ALL patients, particularly concerning CNS involvement.
- The study highlights a potential shift in treatment strategies for adult ALL to mitigate CNS relapse risks.
Abstract:
Central nervous system (CNS) is the common site of extramedullary relapse in adult acute lymphoblastic leukaemia (ALL) and the outcome of CNS relapse patients remains poor. This study aimed to investigate whether a paediatric-inspired chemotherapy regimen can reduce CNS relapse in adult ALL compared to the adult regimen. A total of 1005 newly diagnosed adult patients with ALL were enrolled in this study, including 596 patients who received the Hyper-CVAD (cyclophosphamide, vincristine, doxorubicin[adriamycin], and dexamethason) adult regimen and 409 patients who treated with the Precision Classification-Directed Target Total Therapy-ALL-2016 (PDT-ALL-2016) paediatric-inspired chemotherapy regimen. 11.24% of patients treated with the adult regimen (67/596) experienced a CNS recurrence, whereas only 7.09% of patients (29/409) had CNS relapse under the paediatric-inspired chemotherapy regimen. The 5-year cumulative incidence of relapse in the CNS for the paediatric cohort and adult cohort was 7.09% and 11.24% respectively (p = 0.025). Even for patients in the high-risk group, the 5-year cumulative incidence of CNS relapse was significantly lower in the paediatric cohort compared with the adult cohort (6.75% vs. 13.7%, p = 0.003). The univariate analysis revealed that the paediatric-inspired regimen is a protective factor for reducing CNS relapse (OR = 0.6, p = 0.029). Collectively, our data suggest that paediatric-inspired chemotherapy may reduce the risk of CNS relapse in adult ALL compared to adult regimens.
Related Concept Videos
02:56Treatment Resistant Cancers
01:21Factors Affecting Drug Response: Overview
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...