A Comparison of Dexamethasone plus Vincristine versus Standard Regimen in Induction Therapy of Adult Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Background: Current treatment options of acute lymphoblastic leukemia(ALL) include chemotherapy alone or hematopoietic stem cell transplantation (HSCT) following induction chemotherapy both along with CNS prophylaxis. The usual and standard induction regimens currently administered could have severe complications and mortality.
 Materials and Methods: To lessen induction regimen complications in ALL patients who undergo HSCT, we used a cytoreduction induction regimen including dexamethasone (8 mg, IV, three times a day, for 28 days) and vincristine(1.4 mg/m2, IV, on days 1,8,15 and 22) for 49 newly diagnosed adult ALL patients followed by an early sibling donor HSCT within two months. The results were matched with outcomes of HSCT in 172 ALL patients inducted by standard induction regimen.
 Results: Median follow-up time was 5.41 years in the standard group and 5.27 years in the other. All patients of the case group (100%) achieved complete remission. Landmark analyses were performed to scrutinize the effect of treatments on different time intervals: first two years and 2nd to end years. Type of treatment had no significant effect on the hazard of death in the first landmark (HR=0.87, P=0.64). Cytoreduction regimen amplified the hazard of death 3.43 times more than the standard regimen in the second landmark (HR=3.43 P=0.035). Multivariate analysis showed that the cytoreduction regimen reduced the hazard of relapse about 22%, but not statistically significant (HR=0.78, P-value=0.24).
 Conclusion: Overall, it seems despite achieving complete remission in induction therapy, depth of response is a critical predictor for long-term outcomes of HSCT in ALL patients, and the use of multiple agents may be necessary to decrease tumor cell burden and minimal residual disease(MRD).

Busulfan and subsequent malignancy: An evidence‐based risk assessment

“…Thirteen publications in adult hematologic malignancies were identified describing long‐term results for busulfan/chemotherapy combination pretransplant conditioning regimens, encompassing 2076 patients, predominantly in allogeneic HCT settings 20–32 . Three additional publications described long‐term results in adults (also with hematologic malignancies) when busulfan was combined with TBI and additional chemotherapy agents, involving 744 patients 33–35 .…”

“…14 Thirteen publications in adult hematologic malignancies were identified describing long-term results for busulfan/chemotherapy combination pretransplant conditioning regimens, encompassing 2076 patients, predominantly in allogeneic HCT settings. [20][21][22][23][24][25][26][27][28][29][30][31][32] Three additional publications described long-term results in adults (also with hematologic malignancies) when busulfan was combined with TBI and additional chemotherapy agents, involving 744 patients. [33][34][35] Five of the busulfan/chemotherapy publications and each of the three busulfan/TBI/chemotherapy publications involved median follow-up exceeding 5 years, summarized in Table 3; the remaining eight selected studies involved median follow-up of between 3 and 5 years, summarized in Table 4.…”

Real-Life Data on the Efficacy and Safety of Letermovir for Primary Prophylaxis of Cytomegalovirus in Allogeneic Hematopoietic Stem Cell Recipients: A Single-Center Analysis

“…D/R CMV serological status remains the main risk factor influencing the incidence and mortality of CMV reactivation/disease after HSCT [ 1 , 16 , 34 , 35 ]. It has been demonstrated that seropositive recipients are more likely to experience CMV reactivation if they received a graft from a seronegative donor than from a seropositive one [ 36 , 37 , 38 ]. Nevertheless, CMV reactivation occurs in up to 70% of CMV IgG seropositive allo-recipients regardless of donor status according to some recent studies, and LMV prophylaxis is therefore recommended for all CMV seropositive recipients [ 1 , 11 , 39 ].…”

Psychosocial distress in young adults surviving hematological malignancies: a pilot study

“…This was more pronounced in cancer survivors with androgen deficiency (Greenfield et al 2010 ). Testosterone levels were below the lower level of normal in 84% of male recipients of HSCT for acute leukemia (Vaezi et al 2016 ). Hypogonadism appears to be common after HSCT (Inamoto and Lee 2017 ) and may be another explanation for the lower QoL and higher physical fatigue levels (Savani et al 2011 ) in males compared to females within our study.…”