Pediatric-inspired regimen with late intensification and increased dose of L-asparaginase for adult acute lymphoblastic leukemia: the KALLA 1406/1407 study
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background/Aims: The objective of this study was to evaluate the efficacy and feasibility of the pediatric-inspired regimen of the adult acute lymphoblastic leukemia (ALL) Working Party, the Korean Society of Hematology. Methods: Data of 99 patients with newly diagnosed ALL, who were treated with the KALLA 1406/1407 protocol, were retrospectively analyzed. All patients equally received age-adjusted daunorubicin, vincristine, and prednisolone. L-asparaginase was additionally administered to Philadelphia (Ph)-negative patients according to age, whereas Ph-positive patients received 600 mg/day of imatinib. Results: A total of 99 patients were enrolled in this study, of whom 62 (62.6%) were diagnosed with Ph-negative ALL and 37 (37.3%) were diagnosed with Ph-positive ALL. The median age of patients in the Ph-negative ALL group was 46 years, and that of patients in the Ph-positive ALL group was 49 years. In patients with Ph-negative ALL, 57 (92%) patients achieved complete remission (CR) and CR with incomplete hematologic recovery (CRi). Disease-free survival (DFS) and overall survival (OS) rates at 2 years were estimated to be 42% and 63%, respectively. In patients with Ph-positive ALL, 32 (86%) patients achieved CR/CRi, and 2-year DFS and OS were 31.2% and 49.1%, respectively. Patients who were able to proceed to the allogeneic hematopoietic cell transplantation and younger patients showed significantly superior survival in both Ph-negative ALL and Ph-positive ALL. Neutropenic fever and bacterial infection were the most common and severe adverse events. Conclusions: The KALLA 1406/1407 protocol showed tolerable toxicities in adult ALL patients. Especially, younger patients had more survival benefits with KALLA 1406/1407 protocol.
Abstract
Background/Aims: The objective of this study was to evaluate the efficacy and feasibility of the pediatric-inspired regimen of the adult acute lymphoblastic leukemia (ALL) Working Party, the Korean Society of Hematology. Methods: Data of 99 patients with newly diagnosed ALL, who were treated with the KALLA 1406/1407 protocol, were retrospectively analyzed. All patients equally received age-adjusted daunorubicin, vincristine, and prednisolone. L-asparaginase was additionally administered to Philadelphia (Ph)-negative patients according to age, whereas Ph-positive patients received 600 mg/day of imatinib. Results: A total of 99 patients were enrolled in this study, of whom 62 (62.6%) were diagnosed with Ph-negative ALL and 37 (37.3%) were diagnosed with Ph-positive ALL. The median age of patients in the Ph-negative ALL group was 46 years, and that of patients in the Ph-positive ALL group was 49 years. In patients with Ph-negative ALL, 57 (92%) patients achieved complete remission (CR) and CR with incomplete hematologic recovery (CRi). Disease-free survival (DFS) and overall survival (OS) rates at 2 years were estimated to be 42% and 63%, respectively. In patients with Ph-positive ALL, 32 (86%) patients achieved CR/CRi, and 2-year DFS and OS were 31.2% and 49.1%, respectively. Patients who were able to proceed to the allogeneic hematopoietic cell transplantation and younger patients showed significantly superior survival in both Ph-negative ALL and Ph-positive ALL. Neutropenic fever and bacterial infection were the most common and severe adverse events. Conclusions: The KALLA 1406/1407 protocol showed tolerable toxicities in adult ALL patients. Especially, younger patients had more survival benefits with KALLA 1406/1407 protocol.
참고문헌 (40)
- Pulte D, "Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century", Blood, 113, pp.1408~1411 (2009)
- Hunger SP, "Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005 : a report from the children’s oncology group", J Clin Oncol, 30, pp.1663~1669 (2012)
- Riehm H, "The Berlin childhood acute lymphoblastic leukemia therapy study, 1970–1976", Am J Pediatr Hematol Oncol, 2, pp.299~306 (1980)
- Pulte D, "Survival of adults with acute lymphoblastic leukemia in Germany and the United States", PLoS One, 9, pp.e85554~ (2014)
- Bassan R, "Modern therapy of acute lymphoblastic leukemia", J Clin Oncol, 29, pp.532~543 (2011)
- Storring JM, "Treatment of adults with BCR-ABL negative acute lymphoblastic leukaemia with a modified paediatric regimen", Br J Haematol, 146, pp.76~85 (2009)
- Dores GM, "Acute leukemia incidence and patient survival among children and adults in the United States, 2001-2007", Blood, 119, pp.34~43 (2012)
- Stock W, "Adolescents and young adults with acute lymphoblastic leukemia", Hematology Am Soc Hematol Educ Program, 2010, pp.21~29 (2010)
- Gokbuget N, "Treatment of adult acute lymphoblastic leukemia", Hematology Am Soc Hematol Educ Program, 2006, pp.133~141 (2006)
- Seibel NL, "Treatment of acute lymphoblastic leukemia in children and adolescents : peaks and pitfalls", Hematology Am Soc Hematol Educ Program, 2008, pp.374~380 (2008)
- Stock W, "A pediatric regimen for older adolescents and young adults with acute lymphoblastic leukemia : results of CALGB 10403", Blood, 133, pp.1548~1559 (2019)
- Barry E, "Favorable outcome for adolescents with acute lymphoblastic leukemia treated on Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium Protocols", J Clin Oncol, 25, pp.813~819 (2007)
- Lee SM, "Escalated daunorubicin dosing as an induction treatment for Philadelphia-negative adult acute lymphoblastic leukemia", Ann Hematol, 92, pp.1101~1110 (2013)
- Mitchell CD, "Benefit of dexamethasone compared with prednisolone for childhood acute lymphoblastic leukaemia : results of the UK Medical Research Council ALL97 randomized trial", Br J Haematol, 129, pp.734~745 (2005)
- Larsen EC, "Dexamethasone and high-dose methotrexate improve outcome for children and young adults with high-risk B-acute lymphoblastic leukemia : a report from Children’s Oncology Group Study AALL0232", J Clin Oncol, 34, pp.2380~2388 (2016)
- Panosyan EH, "Asparaginase antibody and asparaginase activity in children with higher-risk acute lymphoblastic leukemia : Children’s Cancer Group Study CCG-1961", J Pediatr Hematol Oncol, 26, pp.217~226 (2004)
- Nachman JB, "Augmented post-induction therapy for children with high-risk acute lymphoblastic leukemia and a slow response to initial therapy", N Engl J Med, 338, pp.1663~1671 (1998)
- Seibel NL, "Early postinduction intensification therapy improves survival for children and adolescents with high-risk acute lymphoblastic leukemia : a report from the Children’s Oncology Group", Blood, 111, pp.2548~2555 (2008)
- Vora A, "Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia(UKALL 2003) : a randomized controlled trial", Lancet Oncol, 15, pp.809~818 (2014)
- Huguet F, "Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia : the GRAALL-2003study", J Clin Oncol, 27, pp.911~918 (2009)
- Durrant IJ, "Intensification of treatment for adults with acute lymphoblastic leukaemia:results of U.K. Medical Research Council rando mized trial UKALL XA. Medical Research Council Working Party on Leukaemia in Adults", Br J Haematol, 99, pp.84~92 (1997)
- Ribera JM, "Late intensification chemotherapy has not improved the results of intensive chemotherapy in adult acute lymphoblastic leukemia. Results of a prospective multicenter randomized trial (PETHEMA ALL-89). Spanish Society of Hematology", Haematologica, 83, pp.222~230 (1998)
- Arber DA, "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia", Blood, 127, pp.2391~2405 (2016)
- Holmfeldt L, "The genomic landscape of hypodiploid acute lymphoblastic leukemia", Nat Genet, 45, pp.242~252 (2013)
- Malard F, "Acute lymphoblastic leukaemia", Lancet, 395, pp.1146~1162 (2020)
- Hoelzer D, "Prognostic factors in a multicenter study for treatment of acute lymphoblastic leukemia in adults", Blood, 71, pp.123~131 (1988)
- Kantarjian H, "Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone(Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia", Cancer, 101, pp.2788~2801 (2004)
- Thomas DA, "Chemoimmunotherapy with a modified hyper-CVAD and rituximab regimen improves outcome in de novo Philadelphia chromosome-negative precursor B-lineage acute lymphoblastic leukemia", J Clin Oncol, 28, pp.3880~3889 (2010)
- Huguet F, "Intensified therapy of acute lymphoblastic leukemia in adults : report of the randomized GRAALL-2005 clinical trial", J Clin Oncol, 36, pp.2514~2523 (2018)
- Tanguy-Schmidt A, "Long-term follow-up of the imatinib GRAAPH-2003study in newly diagnosed patients with de novo Philadelphia chromosome-positive acute lymphoblastic leukemia : a GRAALL study", Biol Blood Marrow Transplant, 19, pp.150~155 (2013)
- Kim DY, "Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia", Blood, 126, pp.746~756 (2015)
- Wieduwilt MJ, "A phase II study of dasatinib and dexamethasone as primary therapy followed by transplantation for adults with newly diagnosed Ph", BCR-ABL1-positive acute lymphoblastic leukemia(Ph+ALL) : final results of Alliance, Blood, pp.2018, 132(Suppl 1)[DOI]
- Ravandi F, "First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive(Ph+)acute lymphoblastic leukemia", Blood, 116, pp.2070~2077 (2010)
- Ho DH, "L-asparagine requirement and the effect of L-asparaginase on the normal and leukemic human bone marrow", Cancer Res, 30, pp.466~472 (1970)
- Onuma T, "Amino acid requirements in vitro of human leukemic cells", Cancer Res, 31, pp.1640~1644 (1971)
- Sobin LH, "A metabolic difference between two lines of lymphoma 6c3hed cells in relation to asparagine", Proc Soc Exp Biol Med, 119, pp.325~327 (1965)
- Amylon MD, "Intensive high-dose asparaginase consolidation improves survival for pediatric patients with T cell acute lymphoblastic leukemia and advanced stage lymphoblastic lymphoma : a Pediatric Oncology Group study", Leukemia, 13, pp.335~342 (1999)
- Wetzler M, "Effective asparagine depletion with pegylated asparaginase results in improved outcomes in adult acute lymphoblastic leukemia : Cancer and Leukemia Group B Study 9511", Blood, 109, pp.4164~4167 (2007)
- Ahlke E, "Dose reduction of asparaginase under pharmacokinetic and pharmacodynamic control during induction therapy in children with acute lymphoblastic leukaemia", Br J Haematol, 96, pp.675~681 (1997)
- Egler RA, "L-asparaginase in the treatment of patients with acute lymphoblastic leukemia", J Pharmacol Pharmacother, 7, pp.62~71 (2016)