Comparison of Two Pediatric-Inspired Regimens to Hyper-CVAD in Hispanic Adolescents and Young Adults With Acute Lymphoblastic Leukemia

HyperCVAD versus pegaspargase‐containing regimens for Hispanic adults with newly diagnosed B‐cell acute lymphoblastic leukemia

“…Although there remains controversy on the best treatment regimen for adult patients, several studies are increasingly supporting the utilization of PEG-CAR. [6][7][8][23][24][25] With a lower cumulative anthracycline, cytarabine, and alkylator exposure, a reduction in subacute and delayed cardio-, neuro-, and myelotoxicity is expected. The toxicity profile of pegaspargase and asparaginase-based products previously limited the adoption of PEG-CAR use in older adults however, recent studies have demonstrated tolerability in patients up to 40 years of age, prompting further investigation.…”

“…The toxicity profile of pegaspargase and asparaginase-based products previously limited the adoption of PEG-CAR use in older adults however, recent studies have demonstrated tolerability in patients up to 40 years of age, prompting further investigation. 8 Four studies to date have compared outcomes between PEG-CAR and HyperCVAD of which three have shown higher leukemia-free survival (LFS) or OS using the former. [6][7][8]26 Additionally, several single-arm studies have demonstrated positive outcomes with a PEG-CAR.…”

“…8 Four studies to date have compared outcomes between PEG-CAR and HyperCVAD of which three have shown higher leukemia-free survival (LFS) or OS using the former. [6][7][8]26 Additionally, several single-arm studies have demonstrated positive outcomes with a PEG-CAR. 24,25 In a retrospective single center study comparing the Dana Farber Consortium Protocol (DFCP) to HyperCVAD, investigators reported a higher 3-year OS rate with the DFCP (72.6% vs. 48.5%).…”

“…Adaptations of treatment regimens originally developed for pediatric ALL patients (also known as pediatric-inspired regimens [PIR]) or adult cooperative group regimens containing pegaspargase (i.e., ECOG-2993, modified BFM-95) have shown favor over HyperCVAD, a commonly utilized adult regimen, in adolescent and young adults' (AYA). [6][7][8] Pegaspargase and other asparaginasebased products are a critical drug component of pegaspargasecontaining ALL regimens (PEG-CAR), thus ensuring tolerance and receipt of as many doses as possible is crucial to optimizing treatment outcomes. Tolerability of pegaspargase was recently demonstrated in a single-center retrospective study of ALL patients aged 40 and older, however, ethnicity was not reported.…”

Treatment of Ph-Negative Acute Lymphoblastic Leukemia in Adolescents and Young Adults with an Affordable Outpatient Pediatric Regimen

“…A multicenter study in Mexico reported a 2year OS of 28.1% using hyperCVAD, which improved to 41.5% after implementing pediatric-inspired regimens. 38 In contrast, a prior experience in Brazil with GMALL 07/2003, a regimen that includes high dose cytarabine and methotrexate, showed high toxicity and poor long-term outcomes across the age spectrum, which was later improved upon by lowering treatment intensity with a 52% 3-year OS in AYAs. 39 It remains to be seen whether longterm outcomes will be comparable to the adjusted CALGB despite its lower intensity and translate to an improvement in compari- son to our historical data from 2004 to 2015, when we employed systemic cytarabine but less vincristine, L-asparaginase, and anthracyclines and reported a 5-year EFS of 32.2% OS of 44.7% in adults < 35 years.…”