title: Final results of a single institution experience with a pediatric-based regimen, the augmented Berlin-Frankfurt-Münster, in adolescents and young adults with acute lymphoblastic leukemia, and comparison to the hyper-CVAD regimen.
abstract: Several studies reported improved outcomes of adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated with pediatric-based ALL regimens. This prompted the prospective investigation of a pediatric Augmented Berlin-Frankfurt-Münster (ABFM) regimen, and its comparison with hyper-fractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone (hyper-CVAD) in AYA patients. One hundred and six AYA patients (median age 22 years) with Philadelphia chromosome- (Ph) negative ALL received ABFM from October 2006 through March 2014. Their outcome was compared to 102 AYA patients (median age 27 years), treated with hyper-CVAD at our institution. The complete remission (CR) rate was 93% with ABFM and 98% with hyper-CVAD. The 5-year complete remission duration (CRD) were 53 and 55%, respectively (P = 0.98). The 5-year overall survival (OS) rates were 60 and 60%, respectively. The MRD status on Day 29 and Day 84 of therapy was predictive of long-term outcomes on both ABFM and hyper-CVAD. Severe regimen toxicities with ABFM included hepatotoxicity in 41%, pancreatitis in 11%, osteonecrosis in 9%, and thrombosis in 19%. Myelosuppression-associated complications were most significant with hyper-CVAD. In summary, ABFM and hyper-CVAD resulted in similar efficacy outcomes, but were associated with different toxicity profiles, asparaginase-related with ABFM and myelosuppression-related with hyper-CVAD. Am. J. Hematol. 91:819-823, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Pediatrics-Patient Care, the University of Texas MD Anderson Cancer Center, Texas.|Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Rytting
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Jabbour
authors.affiliation: Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jorgensen
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.affiliation: Pediatrics-Patient Care, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Franklin
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Tapan M
authors.initials: TM
authors.lastname: Kadia
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Naveen
authors.initials: N
authors.lastname: Pemmaraju
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Naval G
authors.initials: NG
authors.lastname: Daver
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Manero
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Marina Y
authors.initials: MY
authors.lastname: Konopleva
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Gautam
authors.initials: G
authors.lastname: Borthakur
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Garris
authors.affiliation: Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Sa
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Sherry
authors.initials: S
authors.lastname: Pierce
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Kurt
authors.initials: K
authors.lastname: Schroeder
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kornblau
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Thomas
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Cortes
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Susan M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Department of Leukemia, the University of Texas MD Anderson Cancer Center, Texas.
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D001215:Asparaginase / Q000187:drug effects; D002648:Child; D003520:Cyclophosphamide; D003907:Dexamethasone; D004317:Doxorubicin; D005260:Female; D006801:Humans; D008297:Male; D022423:Myeloid Cells / Q000187:drug effects; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012074:Remission Induction; D015996:Survival Rate; D014750:Vincristine; D055815:Young Adult
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D001215:Asparaginase