Efficacy of Hyper-CVAD/MA and CHALL-01 regimens in the treatment of Philadelphia chromosome-positive adult acute lymphoblastic leukemia patients under 60 years old.
10.3760/cma.j.issn.0253-2727.2019.08.001
- Author:
Ai Jie HUANG
1
;
Li Bing WANG
1
;
Juan DU
2
;
Gu Sheng TANG
1
;
Hui CHENG
1
;
Sheng Lan GONG
1
;
Lei GAO
1
;
Hui Ying QIU
1
;
Xiong NI
1
;
Jie CHEN
1
;
Li CHEN
1
;
Wei Ping ZHANG
1
;
Jian Min WANG
1
;
Jian Min YANG
1
;
Xiao Xia HU
1
Author Information
1. Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
2. Department of Hematology, Changzheng Hospital, Second Military Medical University, Shanghai 200433, China.
- Publication Type:Journal Article
- Keywords:
CHALL-01;
Hyper-CVAD/MA;
Leukemia, lymphoblastic, acute;
Philadelphia chromosome
- MeSH:
Adult;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*;
Cyclophosphamide;
Dexamethasone;
Doxorubicin;
Humans;
Middle Aged;
Philadelphia Chromosome;
Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy*;
Retrospective Studies;
Vincristine
- From:
Chinese Journal of Hematology
2019;40(8):625-632
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To compare the difference of efficacy between traditional Hyper-CVAD/MA regimen and the adolescents inspired chemotherapy regimen, CH ALL-01, in treatment of adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL) . Methods: In this study we retrospectively analyzed 158 Ph(+) ALL patients receiving Hyper-CVAD/MA regimen (n=63) or CHALL-01 regimen (n=95) in our center and Changzheng hospital from January 2007 to December 2017, excluding patients with chronic myeloid leukemia in blast crisis. Tyrosine kinase inhibitor (TKI) was administered during induction and consolidation chemotherapy. Patients who underwent hematopoietic stem cell transplantation received TKI as maintenance therapy. Results: Of them, 91.1% (144/158) patients achieved complete remission (CR) after 1-2 courses of induction. CR rate was 90.5% (57/63) for patients in Hyper-CVAD/MA group and 91.6% (87/95) for patients in CHALL-01 group. There was no difference in CR rates between the two groups (χ(2)=0.057, P=0.811) . The last follow-up was June 2018. A cohort of 134 CR patients could be used for further analysis, among them, 53 patients received Hyper-CVAD/MA regimen and other 81 patients received CHALL-01 regimen. The molecular remission rates were significantly higher in CHALL-01 group (complete molecular response: 44.4%vs 22.6%; major molecular response: 9.9% vs 18.9%) (χ(2)=7.216, P=0.027) . For the patients in Hyper-CVAD/MA group, the 4-year overall survival (OS) was 44.81% (95%CI: 30.80%-57.86%) and the 4-year disease free survival (DFS) was 37.95% (95%CI: 24.87%-50.93%) . For patients received CHALL-01 regimen, the 4-year OS was 55.63% (95%CI: 39.07%-69.36%) (P=0.037) and 4 year DFS was 49.06% (95%CI: 34.24%-62.29%) (P=0.015) , while there was no significant difference in 4 year cumulative incidence of relapse (CIR) (P=0.328) or cumulative incidence of nonrelapse mortality (CI-NRM) (P=0.138) . The rate of pulmonary infection was lower in patients received CHALL-01 regimen compared with patients received Hyper-CVAD regimen (43.4% vs 67.9%, χ(2)=7.908, P=0.005) . Conclusions: Outcome with CHALL-01 regimen appeared better than that with the Hyper-CVAD/MA regimen in Ph(+) ALL, which has lower incidence of pulmonary infection, higher molecular remission rate and better OS and DFS.
