Phase 2 study of intensified chemotherapy and allogeneic hematopoietic stem cell transplantation for older patients with acute lymphoblastic leukemia

被引：22

作者：

Fathi, Amir T. ^{[1
]}

DeAngelo, Daniel J. ^{[2
]}

Stevenson, Kristen E. ^{[2
]}

Kolitz, Jonathan E. ^{[3
]}

Asch, Julie D. ^{[4
]}

Amrein, Philip C. ^{[1
]}

Attar, Eyal C. ^{[1
]}

Steensma, David P. ^{[2
]}

Wadleigh, Martha ^{[2
]}

Foster, Julia ^{[1
]}

Connolly, Christine ^{[1
]}

Galinsky, Ilene ^{[2
]}

Devoe, Craig E. ^{[3
]}

Stone, Richard M. ^{[2
]}

Neuberg, Donna S. ^{[2
]}

Ballen, Karen K. ^{[1
]}

机构：

[1] Massachusetts Gen Hosp, Ctr Canc, Zero Emerson Pl,Suite 118, Boston, MA 02114 USA

[2] Dana Farber Canc Inst, Boston, MA 02115 USA

[3] North Shore Long Isl Jewish Hlth Syst, Monter Canc Ctr, Lake Success, NY USA

[4] Latter Day St Hosp, Salt Lake City, UT USA

来源：

CANCER | 2016年 / 122卷 / 15期

关键词：

acute lymphoblastic leukemia; chemotherapy; older adults; Philadelphia chromosome; stem cell transplant; PEDIATRIC-PATIENTS; ADULT PATIENTS; REMISSION INDUCTION; REDUCED-INTENSITY; ELDERLY-PATIENTS; B-PRECURSOR; CLOFARABINE; TRIAL; ADOLESCENTS; DEXAMETHASONE;

D O I：

10.1002/cncr.30037

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BACKGROUNDOutcomes among older patients with acute lymphoblastic leukemia remain poor. This study sought to determine the efficacy of an intensified, multi-agent approach derived from a Dana-Farber consortium trial in younger adults for patients older than 50 years (trial identifier NCT00973752). METHODSThe primary endpoint was overall survival (OS) at 1 year. Patients received induction chemotherapy with vincristine, prednisone, doxorubicin, and pegylated asparaginase. Imatinib was incorporated for Philadelphia chromosome-positive disease. After induction, the first consolidation incorporated clofarabine. Patients in remission could proceed to allogeneic hematopoietic cell transplantation (HCT) after induction and consolidation I. Those not receiving HCT went on to receive central nervous system, consolidation II, and continuation phases of treatment. RESULTSThirty patients were enrolled: 19 achieved a complete remission (CR) after induction and 1 achieved CR after consolidation I for a CR rate of 67%. Sixteen patients underwent HCT. The proportion surviving at 1 year was 63%, and this met the primary endpoint. The 2-year OS rate was 52% (n = 30), and the 2-year disease-free survival rate was 52% for patients achieving CR (n = 20). There was no survival advantage among those undergoing HCT. Therapy-related hyperbilirubinemia prompted adjustments and limitations to asparaginase dosing. CONCLUSIONSIntensified chemotherapy can result in improved outcomes in comparison with historical data. Additional studies of similarly intensive regimens are warranted in this population. Cancer 2016;122:2379-2388. (c) 2016 American Cancer Society.

引用

页码：2379 / 2388

页数：10

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