Background: Pediatric-inspired protocols with prospective monitoring of minimal residual disease (MRD) are considered the standard of intensive treatment for adults with acute lymphoblastic leukemia (ALL). They have been used in the Czech Republic since 2007.
Patients And Methods: Two hundred and ninety-seven patients aged 18-65 years were treated at five hematology centers between 2007-2020 according to the GMALL 07/2003 protocol. This is a retrospective analysis of their treatment outcomes.
Results: In the Ph-negative cohort, 189 (93.1%) patients achieved complete remission, 5 (2.4%) patients were refractory, and early mortality was 3.0%. Seventy (34.5%) patients experienced relapse in a median of 10.6 months. Overall survival (OS) at 3 and 5 years was 63.5% and 55.9%, disease-free survival (DFS) at 3 and 5 years was 54.5% and 49.7%, respectively. Young adults under 35 years of age (P = 0.015), patients without initial CNS infiltration (P = 0.016), with MRD negativity before consolidation treatment (P < 0.001), transplanted in the 1st complete remission (P < 0.001), and subjects treated after 2012 (P = 0.05) had significantly better overall survival. In a multivariate analysis, MRD at week 11 was the only independent factor affecting OS (HR 3.06; P = 0.006). For DFS, baseline CNS infiltration (HR 2.08; P = 0.038) and MRD at week 11 (HR 2.15; P = 0.020) were significant. In the Ph-positive cohort, 84 (89.4%) patients achieved complete remission, 1 (1.0%) patient was refractory, early mortality was 4.3%. Twenty-six (27.7%) patients relapsed in a median of 8.6 months. Survival at 3 and 5 years was 57.2% and 52.4% for OS and 50.2% and 44.9% for DFS, respectively. Transplanted patients and patients diagnosed after 2012 had statistically better overall survival (P < 0.001).
Conclusion: The introduction of pediatric-inspired protocols with treatment intensification according to MRD levels resulted in a significant improvement in the survival outcomes of adult patients with ALL.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.48095/ccko2023382 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Molecular measurable residual disease before transplantation independently predicts survival and relapse risk in adult lysine methyltransferase 2a-rearranged acute myeloid leukemia.
Cancer
January 2025
Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China.
Background: Patients with lysine methyltransferase 2a (KMT2A)-rearranged (KMT2A-r) acute myeloid leukemia (AML) are assigned to intermediate-risk and adverse-risk categories at diagnosis. However, the value of molecular measurable residual disease (MRD) status in patients who have KMT2A-r AML before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult cohorts has rarely been evaluated.
Methods: Patients with KMT2A-r AML who achieved complete remission and subsequently underwent allo-HSCT between January 2015 and January 2023 were included in this analysis.
Effectiveness of Enfortumab-Vedotin for Right Atrial Metastasis Following Total Cystectomy: A Case Report.
Cureus
December 2024
Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, JPN.
Cardiac metastases from bladder cancer are extremely rare and typically associated with a poor prognosis. We here report a case of a 74-year-old woman who had been diagnosed with multiple bladder cancer and later developed pelvic recurrence and multiple bone metastases. Second-line pembrolizumab treatment achieved complete remission.
View Article and Find Full Text PDFWarm Autoimmune Hemolytic Anemia as a Rare Presentation of Pre-fibrotic Primary Myelofibrosis.
Cureus
December 2024
Hematology and Oncology, Olive View University of California Los Angeles (UCLA) Medical Center, Sylmar, USA.
Primary myelofibrosis (PMF) is an uncommon chronic myeloproliferative disorder that is commonly associated with Janus kinase 2 (JAK-2), calreticulin (CALR), or thrombopoietin receptor (MPL) mutations. Pre-fibrotic PMF (also known as pre-PMF or early PMF) is a subtype of PMF that is defined by a lower grade of fibrosis. In this report, we present a rare case of warm autoimmune hemolytic anemia (wAIHA) associated with pre-PMF.
View Article and Find Full Text PDFPulmonary Mucormycosis in an Older Acute Myeloid Leukemia Patient.
J Med Cases
January 2025
Department of Hematology, The Second Affiliated Hospital, Chongqing Medical University, Jiangnan, Chongqing, China.
Mucormycosis is a rare but fatal opportunistic fungal infection. Patients with hematologic malignancies who use immunosuppressant and glucocorticoid extensively are susceptible to mucormycosis. We report a case of an older patient with acute myeloid leukemia (AML) who was infected with pulmonary mucormycosis during chemotherapy.
View Article and Find Full Text PDFSuccessful treatment of recurrent refractory Kaposi's sarcoma in AIDS: a case report.
Front Oncol
December 2024
The Second Infectious Disease Department, Xixi Hospital of Hangzhou, Hangzhou, China.
Kaposi's sarcoma (KS) is a soft tissue lesion that resembles a hyperpigmented angiosarcoma and is typically associated with human herpesvirus 8 (HHV-8) infection. It is most frequently observed in immunocompromised patients, particularly those with AIDS, and is also referred to as HIV-associated Kaposi's sarcoma (AIDS-KS). The disease progresses rapidly, is challenging to manage, and has a high mortality rate.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!