Older patients with newly diagnosed Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) may experience better clinical outcomes when they receive inotuzumab ozogamicin plus mini-hyperfractionated cyclophosphamide, vincristine, and dexamethasone (mini-HCVD) with or without blinatumomab compared with the standard intensive hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD) regimen, according to study results published in Cancer.

This study assessed 135 older patients with newly diagnosed Ph- ALL treated prospectively with inotuzumab ozogamicin plus mini-HCVD with or without blinatumomab (58 patients) or with HCVAD (77 patients).

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Propensity score matching identified 38 patients in each treatment group. Patients in the inotuzumab ozogamicin arm experienced a 98% response rate compared with an 88% response rate in the HCVAD arm. No patients in the inotuzumab ozogamicin arm experienced early death, while 8% of patients in the HCVAD arm did. Rates of death in complete response were 5% in the inotuzumab ozogamicin arm and 17% in the HCVAD arm.

The 3-year event-free survival with propensity score matching was 64% in the inotuzumab ozogamicin arm compared with 34% in the HCVAD arm (P =.003). With propensity score matching, the 3-year overall survival rate was 63% in the inotuzumab ozogamicin arm and 34% in the HCVAD arm (P =.004).

Multivariate analysis indicated independent prognostic factors for survival were age (P =.019; hazard ratio [HR], 1.045) and inotuzumab plus mini-HCVD with or without blinatumomab (P =.020; HR, 0.550).

“The combination of inotuzumab ozogamicin plus mini-HCVD with or without blinatumomab is safe and effective…and confers a better outcome compared with standard HCVAD chemotherapy,” the authors concluded.

Reference

1.     Jabbour EJ, Sasaki K, Ravandi F, et al. Inotuzumab ozogamicin in combination with low-intensity chemotherapy (mini-HCVD) with or without blinatumomab versus standard intensive chemotherapy (HCVAD) as frontline therapy for older patients with Philadelphia chromosome-negative acute lymphoblastic leukemia: A propensity score analysis [published online April 15, 2019]. Cancer. doi:10.1002/cncr.32139