PH negative acute lymphoblastic leukemia in adolescents and young adults treated according a MRD adapted BFM ALL IC 2009 protocol: Argentine real-world data on 171 patients

PH negative acute lymphoblastic leukemia in adolescents and young adults treated according a MRD adapted BFM ALL IC 2009 protocol: Argentine real-world data on 171 patients

Intensified pediatric chemotherapy regimens to treat adolescents and young adults (AYA) patients with Philadelphia negative acute lymphoblastic leukemia (ALL) have been associated with better outcomes. The local BFM 2009-based scheme complements the risk stratification assessing the measurable resid...

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Bibliographic Details
Published in:Annals of hematology Vol. 102; no. 5; pp. 1087 - 1097
Main Authors: Ferrari, Luciana C, Rivas, María M, Navickas, Alicia B, Dick, Hernán, Mela Osorio, María J, Agamennoni, Lucía, Rey, Irene H, Carnelutto, Natalia E, Cazap, Nicolás, Castro, María B, Aranguren, Pedro Negri, Fischman, Laura A, Yupanki, Marco Lincango, Milone, Jorge H, Fernández, Isolda I, Moirano, María M, Belli, Carolina B
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2023
Springer Nature B.V
Subjects:
Disease-Free Survival
Hematology
Humans
Leukemia
Medicine
Medicine & Public Health
Multicenter Studies as Topic
Neoplasm, Residual - drug therapy
Neoplasm, Residual - genetics
Oncology
Original Article
Pediatrics
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Prednisone - therapeutic use
Prognosis
Remission Induction
Retrospective Studies
Risk
Teenagers
Young adults
ALL
real-world
Ph-negative
Latin American
AYA
MRD
Prognostic factors
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Summary:Intensified pediatric chemotherapy regimens to treat adolescents and young adults (AYA) patients with Philadelphia negative acute lymphoblastic leukemia (ALL) have been associated with better outcomes. The local BFM 2009-based scheme complements the risk stratification assessing the measurable residual disease (MRD) along the induction phase with increasing levels of sensitivity. The present retrospective multicenter analysis included 171 AYA (15–40 years) patients treated accordingly between 2013 and 2019. Ninety-one percent obtained morphological complete remission, 67% a negative (<0.1%) MRD at day 33 (TP1), and 78% a negative (<0.01%) MRD at day 78 (TP2). The overall survival (OS) and the event-free survival (EFS) at 2 years were 62%±4.1 and 55%±4.1, respectively. The OS and EFS were significant better for prednisone responders, who achieved <10% BM blast at day 15, a negative MRD at TP1 or at TP2, and for low-risk patients. Age ≤30 years and WBC <30×10 9 /L, particularly among B-phenotype, were also associated with longer OS. In the multivariable analyses, TP1 MRD positive (OS HR 2.8, 95% CI 1.4–5.7, p =0.004; EFS HR 3.0, 95% CI 1.6–5.7, p =0.001) and at TP2 (OS HR 2.6, 95% CI 1.3–5.3, p =0.012; EFS HR 2.6, 95% CI 1.3–5.1, p =0.006) were independently associated with earlier events. Age >30 years was also associated with a shorter survival (HR 3.1, 95% CI 1.3–7.5, p =0.014). Therefore, those 68 patients ≤30 years with TP1/TP2 negative MRD depicted a longer OS (2 years 85%±4.8). Based on our real-world data, the pediatric-based scheme is feasible in Argentina associated with better outcomes for younger AYA patients who achieved negative MRD at day 33 and 78.
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ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-023-05151-3