Real-world treatment patterns in adult patients (pts) with B-cell precursor acute lymphoblastic leukemia (BCP ALL) in first hematologic complete remission (CR1) with and without minimal residual disease (MRD).

Abstract

e18517 Background: B-cell precursor acute lymphoblastic leukemia (BCP ALL) is a rare and debilitating hematologic cancer. Among patients (pts) in complete remission (CR), minimal residual disease (MRD) is a strong prognostic factor for worse survival outcomes. Limited real-world data is available from the United States to characterize treatment patterns in BCP ALL pts. Methods: A chart review was conducted to assess treatment patterns among adult BCP ALL pts with and without MRD in first hematologic CR (CR1) across National Cancer Institute designated cancer centers, academic and community hospitals, and integrated delivery systems. The study period was the date of CR1 until 12 months post-CR1, relapse, or death. Eligible pts were ≥18 years of age with BCP ALL in CR1 between 4/2015 and 3/2017, with no other cancer diagnoses. Results: Overall, 65 (52%) of the 125 pts included in the study received drug therapy for ALL. Of the 79 total unique treatment regimens, the most frequently administered were intensification/consolidation regimens (46.8%), followed by long-term maintenance (36.7%), and preparation for hematopoietic stem cell transplantation (16.5%). Common regimens among Philadelphia chromosome-negative pts included hyper-CVAD (50%), monthly vincristine/prednisone, weekly methotrexate, and daily 6-mercaptopurine (31%), and CALGB 8811 (16.7%). The proportion of pts receiving drug therapy among community hospitals and academic settings were considerably similar (52% vs 48.3%).The majority of physicians selected hyper-CVAD as the standard of care for pts with MRD+ in CR1 (70.3%), with 48.4% of physicians selecting CALGB 8811, 32.8% selecting multiagent chemotherapy, and 29.7% selecting Linker-4, and 23.4% selecting monthly vincristine/prednisone, weekly methotrexate, daily 6-mercaptopurin. Conclusions: Nearly 50% of pts included in this study did not receive drug therapy for ALL (mean age: 47.8 years). The real-world treatment regimens among treated pts observed in this study are consistent with the NCCN guidelines although there is substantial heterogeneity in the management of BCP ALL.