Comparing Outcomes of First-Line Intensive Chemotherapeutic Regimens in Adult Patients With Acute Lymphoblastic Leukemia at a Tertiary Center.
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BACKGROUND: Survival outcomes of acute lymphoblastic leukemia (ALL) in adults remain inferior to those in the pediatric population. Limited data is present directly comparing different first-line intensive regimens in adult patients with ALL. METHODS: We conducted a retrospective study comparing outcomes of first-line intensive chemotherapeutic regimens utilized in adult ALL patients at Cleveland Clinic. Outcomes included composite complete response (CCR), minimal residual disease (MRD) flow cytometry (FC-MRD) response, overall survival (OS) and event-free survival (EFS). Multivariable regression and propensity score (PS) weighting were used for adjustment. RESULTS: Out of 161 adult patients with ALL between January, 2017 and August, 2023, 100 received an intensive regimen. Of those, 33% (n = 33) received a pediatric-inspired regimen (PIR) (CALGB-10403, n = 32 (97%)), 39% (n = 39) received CALGB-19802, and 28% (n = 28) received Hyper-CVAD. The median age (IQR) was 27 (21-34) for PIR group, 59 (52-65) years for CALGB-19802 group, and 57 (41-66) years for Hyper-CVAD group. The CCR rates were 88%, 82%, and 81% in PIR, CALGB-19802, and Hyper-CVAD groups. The 3-year OS was 78% (95% CI, 63-95), 58% (95% CI, 44-77), and 70% (95% CI, 52-93) (P = .2) in the above groups, respectively. Hyper-CVAD was associated with a higher odds of FC-MRD negative response to CALGB-19802 (PS-adjusted odds ratio: 3.72, 95% CI, 1.05-14.7, P = .041). The 3-year PS-adjusted OS in Hyper-CVAD was 71% (95% CI, 52-97) compared to 49% (95% CI, 33-73) in CALGB-19802 (P = .14). CONCLUSIONS: Compared to an asparaginase-utilizing regimen, CALGB-19802, Hyper-CVAD was associated with higher FC-MRD negative responses. The long-term survival outcomes for patients receiving PIR in young individuals were comparable to those of Hyper-CVAD. Future combination therapies involving blinatumomab and inotuzumab ozogamicin are expected to enhance these outcomes.