ALL-471 Long-Term Results of the Treatment of Adolescents and Adults With Acute Lymphoblastic Leukemia With a Pediatric-Inspired Regimen Delivered on an Outpatient Basis: A Single Institution Experience

Abstract

The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem produce better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude's TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80% of patients were able to receive the initial seven-week period of induction/consolidation fully as outpatients and 77% achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48%. In adults, the median probability of OS was 24 months, and the 5-year OS was 32%. Patients with T-cell ALL did significantly worse than those with a B-cell phenotype (OS at 5 years 17 versus 40%, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone). We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC.