title: Augmented hyper-CVAD based on dose-intensified vincristine, dexamethasone, and asparaginase in adult acute lymphoblastic leukemia salvage therapy.
abstract: The prognosis of adult patients with relapsed acute lymphoblastic leukemia (ALL) remains poor. Recent studies in adolescents and young adults reported better outcomes when therapy was intensified. Based on hyper-CVAD (cyclophosphamide/vincristine/doxorubicin/dexamethasone) as a backbone, we designed an augmented version with intensified doses of vincristine, dexamethasone, and asparaginase (L-asparaginase in the first 62 patients and pegaspargase in the remainder) starting from course 1. Ninety patients have been enrolled, with a median age of 34 years (range, 14-70 years). Most patients (78%) had pre-B ALL and were in first salvage (76%), with a first remission duration of 12.6 months (range, 1-78 months). Ten patients had primary refractory disease. Of 88 evaluable patients, 41 (47%) achieved complete remission (CR), with a median time to CR of 29 days (range, 18-80 days). Eight patients (9%) died within the first 30 days. Median CR duration, progression-free survival, and overall survival were 5, 6.2, and 6 months, respectively. Median overall survival of CR patients was 10.2 months (range, 1.4-69.5+ months). Twenty-eight patients (32%) proceeded to stem cell transplantation. Myelosuppression-associated complications were frequent. Pegaspargase was equally effective and easier to administer than L-asparaginase. Augmented hyper-CVAD may be suitable to be studied in younger adults with untreated ALL.
authors: Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77230-9616, USA. sfaderl@mdanderson.org
authors: Stefan
authors: S
authors: Faderl
authors: Deborah Ann
authors: DA
authors: Thomas
authors: Susan
authors: S
authors: O'Brien
authors: Farhad
authors: F
authors: Ravandi
authors: Guillermo
authors: G
authors: Garcia-Manero
authors: Gautam
authors: G
authors: Borthakur
authors: Alessandra
authors: A
authors: Ferrajoli
authors: Srdan
authors: S
authors: Verstovsek
authors: Mohamed
authors: M
authors: Ayoubi
authors: Michael
authors: M
authors: Rytting
authors: Jennie
authors: J
authors: Feliu
authors: Hagop M
authors: HM
authors: Kantarjian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011379:Prognosis; D016879:Salvage Therapy; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D001215:Asparaginase