Clinical Outcomes of Younger Adults With Philadelphia‐Negative Acute Lymphoblastic Leukemia, Treated With A Pediatric‐Like Regimen Based on the GIMEMA LAL1308 Protocol. A Campus ALL Study

Vollständiger Abstract

Worum geht es in dieser Arbeit?

ABSTRACT Introduction While pediatric‐based protocols have significantly improved survival rates in adolescents and young adult (AYA) patients with Philadelphia‐negative acute lymphoblastic leukemia (Ph‐ ALL), limited information is available on the applicability of pediatric‐like chemotherapy in real life outside of clinical trials. Methods We retrospectively collected clinical data from 36 AYA patients (median age 21 years, range 18–38) with Ph‐ ALL (28) or lymphoblastic lymphoma (LL) (8) who received a frontline treatment inspired by the GIMEMA LAL1308 pediatric protocol in a multicenter real‐life setting, across centers participating in the Campus ALL network. Results A morphologic or radiologic/metabolic complete remission was documented in 31/36 (86.1%) ALL/LL patients after induction Phase Ib. Measurable residual disease (MRD) negativity was reached in 17/23 (73.9%) evaluable ALL patients at the prognostic timepoint at the end of Ib induction cycle. Consolidation/maintenance approaches followed risk‐adapted indications, with 20 (55.6%) patients receiving an allogeneic hematopoietic stem cell transplantation (allo‐HSCT) because of either adverse prognostic factors, resistance to induction treatment, morphologic relapse, or MRD positivity. The 5‐year overall, disease‐free, and event‐free survival rates were 76.4%, 69.1%, and 59%, respectively. No significant differences in outcomes were observed according to the ALL/LL diagnosis, B/T lineage, risk stratification, allo‐HSCT procedure, and, surprisingly, MRD status, probably due to the limited sample size or to optimal risk‐adapted and MRD‐driven intensification strategies. Conclusions The implementation of this unmodified pediatric regimen to Ph‐ AYA ALL patients appears feasible in a real‐life context, with results that compare favorably to those of other pediatric‐based regimens not yet incorporating frontline immunotherapy.