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Lee BJ, Griffin SP, Doh J, Chan A, Ciurea SO, Jeyakumar D, Fleischman AG, Naqvi K, Pannunzio NR, O'Brien S, Kongtim P. HyperCVAD versus pegaspargase-containing regimens for Hispanic adults with newly diagnosed B-cell acute lymphoblastic leukemia. Eur J Haematol 2024; 112:392-401. [PMID: 37933194 DOI: 10.1111/ejh.14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE There are significant disparities in outcomes among Hispanic patients with acute lymphoblastic leukemia (ALL). Recent studies have demonstrated favorable outcomes of pegaspargase-containing ALL regimens (PEG-CAR) in young adults however, outcomes in Hispanic ethnicity continue to be underreported. METHODS We evaluated outcomes of newly diagnosed, adult B-cell ALL Hispanic and non-Hispanic patients consecutively treated with a PEG-CAR or HyperCVAD between January 2011 and November 2022. The primary endpoint was event-free survival (EFS) while secondary endpoints included cumulative incidence of relapse and overall survival (OS). RESULTS Among 105 included patients, 48 (45.7%) were treated with a PEG-CAR and 57 (54.3%) with HyperCVAD. Median age was 38 years (range, 18-75 years), 61% were Hispanic, and 35.2% had poor-genetic risk. Hispanic patients demonstrated significantly worse 5-year EFS with a PEG-CAR compared to that seen with HyperCVAD (HR, 2.58; 95% CI, 1.32-5.04; p = .006) whereas non-Hispanic patients had better outcomes with PIR (52.4% vs. 42.0%). Hispanic ethnicity (p = .015) and male sex (p = .019) were independent predictors for poor OS. CONCLUSIONS Hispanic patients with B-cell ALL had worse EFS with a PEG-CAR as compared with HyperCVAD. Future studies will aim to confirm these findings and establish a tailored treatment approach for this high-risk population.
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Affiliation(s)
- Benjamin J Lee
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California, USA
| | - Shawn P Griffin
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California, USA
| | - Jean Doh
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Alexandre Chan
- Department of Pharmacy, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, California, USA
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Stefan O Ciurea
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Deepa Jeyakumar
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Angela G Fleischman
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Kiran Naqvi
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Nicholas R Pannunzio
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Susan O'Brien
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
| | - Piyanuch Kongtim
- Department of Medicine, Division of Hematology Oncology, Chao Family Comprehensive Cancer Center, University of California Irvine Health, Orange, California, USA
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2
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Silva W, Rego E. How to Manage Philadelphia-Positive Acute Lymphoblastic Leukemia in Resource-Constrained Settings. Cancers (Basel) 2023; 15:5783. [PMID: 38136329 PMCID: PMC10741425 DOI: 10.3390/cancers15245783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/24/2023] Open
Abstract
Recent studies have indicated that more than half of adult patients newly diagnosed with Ph+ ALL can now achieve a cure. However, determining the most suitable protocol for less-resourced settings can be challenging. In these situations, we must consider the potential for treatment toxicity and limited access to newer agents and alloSCT facilities. Currently, it is advisable to use less intensive induction regimens for Ph+ ALL. These regimens can achieve high rates of complete remission while causing fewer induction deaths. For consolidation therapy, chemotherapy should remain relatively intensive, with careful monitoring of the BCR-ABL1 molecular transcript and minimal residual disease. AlloSCT may be considered, especially for patients who do not achieve complete molecular remission or have high-risk genetic abnormalities, such as IKZF1-plus. If there is a loss of molecular response, it is essential to screen patients for ABL mutations and, ideally, change the TKI therapy. The T315I mutation is the most common mechanism for disease resistance, being targetable to ponatinib. Blinatumomab, a bispecific antibody, has shown significant synergy with TKIs in treating this disease. It serves as an excellent salvage therapy, aside from achieving outstanding results when incorporated into the frontline.
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Affiliation(s)
- Wellington Silva
- Discipline of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-010, Brazil;
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3
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Molina JC. Leveraging health care technology to improve health outcomes and reduce outcome disparities in AYA leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:573-580. [PMID: 38066875 PMCID: PMC10727055 DOI: 10.1182/hematology.2023000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Significant improvements have occurred for adolescent and young adult (AYA) B-cell acute lymphoblastic leukemia (B-ALL) patients following the widespread adoption of "pediatric-inspired" treatment regimens for AYA patients cared for in adult oncology settings. However, for AYA patients, aged 15 to 39, an outcomes gap remains in B-ALL, necessitating the incorporation of novel therapies into up-front treatment regimens. As a result, clinical trial enrollment remains the current standard of care for AYA B-ALL across disease subtypes when available and accessible. Currently, several up-front trials are looking to incorporate the use of inotuzumab, blinatumomab, and chimeric antigen receptor T-cell therapy into existing chemotherapy backbones for AYA patients, as well as tyrosine kinase inhibitors for both Philadelphia-positive (Ph+) and Ph-like B-ALL. In addition to ongoing attempts to improve up-front treatments by incorporating immunotherapy and targeted approaches, the increased use of next generation sequencing for measurable residual disease evaluation has led to superior risk-stratification and a decreased need to pursue consolidative hematopoietic stem cell transplantation during the first complete remission for many patients.
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Affiliation(s)
- John C. Molina
- Leukemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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4
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Zeckanovic A, Fuchs P, Heesen P, Bodmer N, Otth M, Scheinemann K. Pediatric-Inspired Regimens in the Treatment of Acute Lymphoblastic Leukemia in Adolescents and Young Adults: A Systematic Review. Curr Oncol 2023; 30:8612-8632. [PMID: 37754540 PMCID: PMC10528122 DOI: 10.3390/curroncol30090625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) have significantly worse outcomes than their younger counterparts. Current treatment guidelines rely mostly on non-randomized retrospective studies. We performed a systematic review of studies published within the last 15 years comparing pediatric-inspired regimens (PIR) versus adult-type regimens or performing an age-stratified analysis of outcomes in the AYA population. Due to the heterogeneity of data, a meta-analysis was not possible. However, the gathered data show a trend toward improvement in outcomes and an acceptable toxicity profile in patients treated with PIRs compared to conventional adult-type regimens. There is still room for further improvement, as older patients within the AYA population tend to perform poorly with PIR or conventional adult-type chemotherapy. Further randomized studies are needed to develop an optimal treatment strategy for AYA with ALL.
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Affiliation(s)
- Aida Zeckanovic
- Department of Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland; (P.F.); (N.B.); (M.O.)
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Philipp Fuchs
- Department of Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland; (P.F.); (N.B.); (M.O.)
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Philip Heesen
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Nicole Bodmer
- Department of Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland; (P.F.); (N.B.); (M.O.)
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Maria Otth
- Department of Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland; (P.F.); (N.B.); (M.O.)
- Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Division of Hematology/Oncology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland;
- Faculty of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
| | - Katrin Scheinemann
- Division of Hematology/Oncology, Children’s Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland;
- Faculty of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- Department of Pediatrics, McMaster Children’s Hospital and McMaster University, Hamilton, ON L8S 4L8, Canada
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5
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Basquiera AL, Seiwald MC, Best Aguilera CR, Enciso L, Fernandez I, Jansen AM, Nunes E, Sanchez del Villar M, Urbalejo Ceniceros VI, Rocha V. Expert Recommendations for the Diagnosis, Treatment, and Management of Adult B-Cell Acute Lymphoblastic Leukemia in Latin America. JCO Glob Oncol 2023; 9:e2200292. [PMID: 37167576 PMCID: PMC10497277 DOI: 10.1200/go.22.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/19/2023] [Accepted: 03/13/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Despite strong induction chemotherapy response rates, only 30%-40% of patients with adult B-cell acute lymphoblastic leukemia (ALL) attain long-term remission. This study analyzes ALL in Latin America (LA) and recommends diagnosis, treatment, and management protocols. METHODS The Americas Health Foundation organized a panel of hematologists from Argentina, Brazil, Chile, Colombia, and Mexico to examine ALL diagnosis and therapy and produce recommendations. RESULTS Lack of regional data, unequal access to diagnosis and therapy, inadequate treatment response, and uneven health care distribution complicate adult ALL management. The panel recommended diagnosis, first-line and refractory treatment, and post-transplantation maintenance. Targeted treatments, including rituximab, blinatumomab, and inotuzumab ozogamicin, are becoming available in LA and must be equitably accessed. CONCLUSION This review adapts global information on treating ALL to LA. Governments, the medical community, society, academia, industry, and patient advocates must work together to improve policies.
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Affiliation(s)
- Ana Lisa Basquiera
- Hematology and Oncology Service, Bone Marrow Transplant Program, Hospital Privado Universitario de Cordoba, Instituto Universitario de Ciencias Biomédicas de Cordoba (IUCBC), Cordoba, Argentina
| | - Maria Cristina Seiwald
- Department of Clinical Medicine, Hematology and Hemotherapy, University of Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - Carlos Roberto Best Aguilera
- Conacyt National Quality Postgraduate Program, University of Guadalajara & Western General Hospital, Guadalajara, Mexico
| | | | | | | | - Elenaide Nunes
- Hospital de Clínicas—Federal University of Parana, Parana, Brazil
| | - Matias Sanchez del Villar
- Chief Bone Marrow Transplant Service, Department of Hematology, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Vanderson Rocha
- Department of Clinical Medicine, Hematology and Hemotherapy, University of Sao Paulo (FMUSP), Sao Paulo, Brazil
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6
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Treatment of Ph-Negative Acute Lymphoblastic Leukemia in Adolescents and Young Adults with an Affordable Outpatient Pediatric Regimen. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:883-893. [PMID: 36057522 DOI: 10.1016/j.clml.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND B-cell acute lymphoblastic leukemia is frequent in Hispanic adolescents and young adults. Outcomes of implementation of pediatric-inspired regimens in low-and middle-income countries are not well known. METHODS In this study we treated 94 adolescents and young adults with a local BFM regimen designed to be affordable with the use of native L-asparaginase and mitoxantrone administered in an outpatient fashion, and the of BCR/ABL and measurable residual disease (MRD) determined by high sensitivity flow cytometry for risk stratification. RESULTS Induction mortality was 11%; 25% of patients had to abandon treatment or be transferred to another health system. Two-year overall (OS) and event free survival (EFS) were 61.5% and 49.8%, MRD-negative patients had a 24-month OS of 85.6% vs. 69.6% (p = .024) and EFS of 76% vs. 45.5% (p = .004). Patients older than 40 years and those who abandoned treatment had worse EFS. Overall drug costs in our regimen were 52% lower than those of CALGB10403. CONCLUSION The treatment of AYAs with ALL with an outpatient focus was implemented successfully at a reduced cost. Genetic risk assessment, treatment abandonment and lack of access to novel therapies remain major barriers for improving outcomes.
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7
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Colunga-Pedraza PR, Colunga-Pedraza JE, Peña-Lozano SP, Gómez-De León A, Ruiz-Delgado GJ, Ribeiro RC. Diagnosis and treatment of acute lymphoblastic leukemia in Latin America. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:971-976. [PMID: 36040187 DOI: 10.1080/16078454.2022.2117119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE to discuss the status and challenges associated with the management of acute lymphoblastic leukemia (ALL) in Latin America. METHODS This review summarizes various insights gained from information regarding diagnostic approaches and treatment strategies in adult patients with ALL in Latin American Countries. RESULTS Information regarding ALL in Latin America is scarce; however, many efforts have been made to overcomes these barriers. Nevertheless, major obstacles to successful treatment in Latin America and LMIC remain poor adherence, abandonment of treatment, and lack of supportive therapy and new therapeutic agents. CONCLUSION Further improvements in survival should be pursued by developing more Latin American registries, forming cooperative groups, developing educational models to facilitate earlier diagnosis and prevention of complications, better support therapy and management of infections, and adapting treatment strategies.
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Affiliation(s)
- Perla R Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Julia E Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Samantha P Peña-Lozano
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Hematología, Hospital Universitario "Dr. José E. González", Monterrey, Mexico
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Mexico.,Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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8
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García-Villaseñor E, Cortés JE, Reyes-Cisneros OA, Fernández-Gutiérrez JA, Sánchez-Bonilla D, Bojalil-Álvarez L, Murrieta-Álvarez I, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Long-term results of the treatment of adolescents and adults with acute lymphoblastic leukemia with a pediatric-inspired regimen delivered on an outpatient basis: A single institution experience. Leuk Res 2022; 121:106935. [PMID: 36037624 DOI: 10.1016/j.leukres.2022.106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Abstract
The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem to be related with better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude´s TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80 % of patients were able to receive the initial seven-week period of induction / consolidation fully as outpatients and 77 % achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48 %. In adults, the median probability of OS was 24 months, and the 5-year OS was 32 %. Patients with T-cell ALL did significantly worse than those with a B cell phenotype (OS at 5 years 17 versus 40 %, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD. We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC.
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Affiliation(s)
- Elizabeth García-Villaseñor
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Benemérita Universidad Autónoma de Puebla, Puebla, Pue, Mexico
| | - Jorge E Cortés
- Georgia Cancer Center. Augusta University, Augusta, GA, USA
| | - Oscar A Reyes-Cisneros
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Anáhuac Puebla, Puebla, Pue, Mexico
| | - José A Fernández-Gutiérrez
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico
| | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico
| | - Lorena Bojalil-Álvarez
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico
| | - Iván Murrieta-Álvarez
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico; Laboratorios Ruiz, Puebla, Pue, Mexico
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Pue, Mexico; Laboratorios Ruiz, Puebla, Pue, Mexico.
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9
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Silva WF, Amano MT, Perruso LL, Cordeiro MG, Kishimoto RK, de Medeiros Leal A, Nardinelli L, Bendit I, Velloso ED, Rego EM, Rocha V. Adult acute lymphoblastic leukemia in a resource-constrained setting: outcomes after expansion of genetic evaluation. Hematology 2022; 27:396-403. [PMID: 35344469 DOI: 10.1080/16078454.2022.2052602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a challenging disease with a growing genetic landscape, even though there is substantial gap between developed and non-developed countries when it comes to availability of such new technologies. This manuscript reports a 5-year retrospective cohort of newly diagnosed ALL patients and their genetic findings and outcomes. An expanded genetic evaluation by using FISH and RT-PCR was implemented, aiming to identify Ph-like alterations. Patients were treated according to our local protocol, which allocated patients according to age and Philadelphia-chromosome status. A total of 104 patients was included, with median age of 37.5 years. Philadelphia chromosome was detected in 33 cases of B-lineage. Among 45 Ph-negative B-lineage, after excluding KMT2A or TCF3-PBX1 cases, we identified 9 cases with Ph-like fusion. Ph-positive and Ph-like patients had higher initial WBC (p = 0.06). Out of 104 cases, two cases did not start chemotherapy and an early death rate of 10.8% was found. Allogeneic transplantation was performed in 18 cases, being ten performed in first CR. Three-year overall survival (OS) and 3-year event-free survival were 42.8% and 30.8%, respectively. For patients treated with a pediatric regimen, 3-year OS was 52.5%. Extramedullary disease (HR 0.42) and platelet counts (HR 0.9) were independently associated with OS. We still face excessive non-relapse mortality that compromises our results. Alternative strategies implementing FISH and RT-PCR are feasible and able to identify Ph-like fusions. Delays in allogeneic transplantation, as well as the unavailability of new agents, impact long-term survival. Measures to decrease early infection are desirable.
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Affiliation(s)
- Wellington F Silva
- Division of Hematology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariane T Amano
- Instituto Sírio-Libanês de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Luiza L Perruso
- Division of Hematology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Maria Gabriella Cordeiro
- Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Aline de Medeiros Leal
- Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciana Nardinelli
- Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Israel Bendit
- Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Elvira Drp Velloso
- Division of Hematology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo M Rego
- Division of Hematology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vanderson Rocha
- Division of Hematology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Division of Hematology, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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10
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Bleyer A. Important factors improving outcome of young adults with acute lymphoblastic leukemia (ALL). Best Pract Res Clin Haematol 2021; 34:101322. [PMID: 34865694 DOI: 10.1016/j.beha.2021.101322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Four categories of important factors improving outcome of young adults and older adolescents with acute lymphoblastic leukemia (ALL) are biologic type, clinical trials, pediatric vs. adult treatment regimen, and psychosocial challenges. Overall, the outcome of ALL in the age group has improved and beginning to catch up with that in children, as exemplified by CALGB 10403, a pediatric treatment regimen. Each is dependent for optimum development, however, on progress in the others. Without adequate psychosocial support and improvement, progress in clinical trials, translational research, and pediatric regimen application is impaired. Without clinical trials, advances in translational research, optimal pediatric regimen application and adequate psychosocial research are restricted. Overall, we have improved the outcome and outlook of ALL in AYAs, as exemplified by CALGB 10403, but we and our current and future patients still have a long way to go.
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Affiliation(s)
- Archie Bleyer
- Oregon Health and Science University, 2884 NW Horizon Dr. Bend, 97703, Portland, OR, USA; University of Texas McGovern Medical School, Houston, TX, USA.
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