Among adolescent and young adult (AYA) patients with Philadelphia-negative acute lymphoblastic leukemia (ALL), combination cyclophosphamide, vincristine, doxorubicin, and dexamethasone plus methotrexate and cytarabine (HyperCVAD) does not appear to improve overall survival (OS) compared with pediatric-inspired protocols (PIPs), according to research presented at the SOHO 2023 Annual Meeting. There was, however, evidence that PIPs may improve event-free and relapse-free survival rates.
PIPs include predefined regimens, such as the CALGB 10403 regimen, the aBFM regimen, and the GRAALL-2005, all of which have been investigated in clinical trials, although data are mixed about whether PIPs yield superior outcomes to other treatment strategies.
For this retrospective cohort study, researchers evaluated whether PIPs improve clinical outcomes compared with HyperCVAD among AYA patients with Philadelphia-negative ALL.
Overall, data from 113 patients were included in this analysis. Although patient characteristics were balanced between the 2 groups, patients in the PIPs group were younger (mean, 23 years) than were patients in the HyperCVAD group (mean, 27 years; P =.018).
Analysis of clinical outcomes suggested that the 2-year event-free survival rates were superior in the PIPs group (80.6% vs 52.6% in the HyperCVAD group; P =.004); 2-year relapse-free survival rates were similarly improved (93.7% vs 59.6%, respectively; P =.0001).
OS was not, however, significantly different between the 2 groups: the 2-year OS rates were 80.3% and 65.7% in the PIPs and HyperCVAD groups, respectively (P =.158).
An analysis of secondary outcomes showed that relapse was more common with HyperCVAD (38.6% vs 5.6%; P =.005). “Prospective trials comparing both adult and PIPs are warranted,” the study’s presenter said.
Shahin O, Makoseh M, Al-Rabie K, et al. Comparison of treatment outcomes in adolescents and young adults (AYA) with Philadelphia negative acute lymphoblastic leukemia (ALL) treated with HyperCVAD and pediatric-inspired protocols (PIPs). Presented at: the Eleventh Annual Meeting of the Society of Hematologic Oncology (SOHO); September 6-9, 2023. Abstract ALL-363.