Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country
Purpose: Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods: Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our cen...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2018-02-01
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| Series: | Journal of Global Oncology |
| Online Access: | http://ascopubs.org/doi/10.1200/JGO.17.00014 |
| _version_ | 1818136570074497024 |
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| author | Punit Jain Anu Korula Prashant Deshpande Nisham PN Ansu Abu Alex Aby Abraham Alok Srivastava Nancy Beryl Janet Kavitha M. Lakshmi Poonkuzhali Balasubramanian Biju George Vikram Mathews |
| author_facet | Punit Jain Anu Korula Prashant Deshpande Nisham PN Ansu Abu Alex Aby Abraham Alok Srivastava Nancy Beryl Janet Kavitha M. Lakshmi Poonkuzhali Balasubramanian Biju George Vikram Mathews |
| author_sort | Punit Jain |
| collection | DOAJ |
| description | Purpose: Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods: Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our center were analyzed. Standard-risk (SR) patients were offered treatment with a modified German Multicenter ALL (GMALL) regimen, whereas high-risk (HR) patients were offered intensification of therapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD). Because of resource constraints, a proportion of HR patients opted to receive the same treatment regimen as used for SR patients. Results: There were 344 SR patients (67.8%) and 163 HR patients (32.2%) at diagnosis. Among the HR patients, 53 (32.5%) opted to receive intensification with the HCVAD regimen. The SR cohort showed a superior 5-year event-free survival rate compared with the HR cohort (47.3% v 23.6%, respectively; P < .001). Within the HR subgroup, there was no statistically significant difference in overall survival or event-free survival between patients who received the modified GMALL regimen (n = 59) and patients who received HCVAD (n = 53). Conclusion: Intensified therapy in the HR subset was associated with a significant increase in early treatment-related mortality and cost of treatment. A modified GMALL regimen was found to be cost-effective with clinical outcomes comparable to those achieved with more intensive regimens. |
| first_indexed | 2024-12-11T09:42:30Z |
| format | Article |
| id | doaj.art-9e03d352c9ba4a03b06d77a5f72ec922 |
| institution | Directory Open Access Journal |
| issn | 2378-9506 |
| language | English |
| last_indexed | 2024-12-11T09:42:30Z |
| publishDate | 2018-02-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | Journal of Global Oncology |
| spelling | doaj.art-9e03d352c9ba4a03b06d77a5f72ec9222022-12-22T01:12:38ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062018-02-014111210.1200/JGO.17.0001414Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing CountryPunit JainAnu KorulaPrashant DeshpandeNisham PNAnsu Abu AlexAby AbrahamAlok SrivastavaNancy Beryl JanetKavitha M. LakshmiPoonkuzhali BalasubramanianBiju GeorgeVikram MathewsPurpose: Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods: Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our center were analyzed. Standard-risk (SR) patients were offered treatment with a modified German Multicenter ALL (GMALL) regimen, whereas high-risk (HR) patients were offered intensification of therapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD). Because of resource constraints, a proportion of HR patients opted to receive the same treatment regimen as used for SR patients. Results: There were 344 SR patients (67.8%) and 163 HR patients (32.2%) at diagnosis. Among the HR patients, 53 (32.5%) opted to receive intensification with the HCVAD regimen. The SR cohort showed a superior 5-year event-free survival rate compared with the HR cohort (47.3% v 23.6%, respectively; P < .001). Within the HR subgroup, there was no statistically significant difference in overall survival or event-free survival between patients who received the modified GMALL regimen (n = 59) and patients who received HCVAD (n = 53). Conclusion: Intensified therapy in the HR subset was associated with a significant increase in early treatment-related mortality and cost of treatment. A modified GMALL regimen was found to be cost-effective with clinical outcomes comparable to those achieved with more intensive regimens.http://ascopubs.org/doi/10.1200/JGO.17.00014 |
| spellingShingle | Punit Jain Anu Korula Prashant Deshpande Nisham PN Ansu Abu Alex Aby Abraham Alok Srivastava Nancy Beryl Janet Kavitha M. Lakshmi Poonkuzhali Balasubramanian Biju George Vikram Mathews Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country Journal of Global Oncology |
| title | Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country |
| title_full | Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country |
| title_fullStr | Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country |
| title_full_unstemmed | Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country |
| title_short | Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country |
| title_sort | adult acute lymphoblastic leukemia limitations of intensification of therapy in a developing country |
| url | http://ascopubs.org/doi/10.1200/JGO.17.00014 |
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