Augmented Hyper-CVAD Based on Dose-Intensified Vincristine, Dexamethasone, and Asparaginase in Adult Acute Lymphoblastic Leukemia Salvage Therapy

Faderl, Stefan; Thomas, Deborah A.; O’Brien, Susan; Ravandi, Farhad; Garcia‐Manero, Guillermo; Borthakur, Gautam; Ferrajoli, Alessandra; Verstovšek, Srđan; Ayoubi, Mohamed; Rytting, Michael; Feliu, J.; Kantarjian, Hagop M.

doi:10.3816/clml.2011.n.007

Cited by 59 publications

(47 citation statements)

References 16 publications

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“…2 Moreover, although this may be comparable with rates observed with hyper-CVAD or augmented hyper-CVAD protocols (44% to 60%), 3,4 it should be recognized that CR/CRp in these previous studies were achieved sometimes after several cycles and not one, as evaluated here. Disease improvement provided by the Cheprall regimen was, however, short-lived, which could be explained by an insufficient decrease in disease load and/or by failure of the blast cells to respond to epratuzumab.…”

Section: Characteristics Of Patients N=30mentioning

confidence: 72%

Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia

Chevallier

Chantepie

Huguet³

et al. 2017

Haematologica

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Section: Characteristics Of Patients N=30mentioning

confidence: 72%

Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia

Chevallier

Chantepie

Huguet³

et al. 2017

Haematologica

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“…114 A phase II study from MD Anderson Cancer Center evaluated an augmented hyper-CVAD regimen (that incorporated asparaginase, intensified vincristine, and intensified dexamethasone) as therapy in adults with relapsed/refractory ALL (n = 90; median age, 34 years; range, 14-70 years; median 1 prior regimen). 115 Among evaluable patients (n = 88), the CR rate was 47%; an additional 13% experienced a CRp and 5% experienced a partial remission. The 30-day mortality rate was 9%, and was lower among the subgroup who received pegaspargase than those who received L-asparaginase (1% vs 12%).…”

Section: Treatment Of Relapsed Ph-negative Allmentioning

confidence: 99%

“…In this study, 32% of patients were able to proceed to HCT. 115 Nelarabine is a nucleoside analog that is currently approved for the treatment of patients with T-cell ALL who have not experienced disease response to or who have relapsed disease after at least 2 chemo-therapy regimens. 116 A phase II study of nelarabine monotherapy in children and adolescents with relapsed/refractory T-cell ALL or T-cell non-Hodgkin's lymphoma (n = 121) showed a 55% response rate among the subgroup with T-cell ALL with first bone marrow relapse (n = 34) and a 27% response rate in the subgroup with a second or greater bone marrow relapse (n = 36).…”

Section: Treatment Of Relapsed Ph-negative Allmentioning

confidence: 99%

Acute Lymphoblastic Leukemia, Version 2.2015

Alvarnas

Brown

Aoun

et al. 2015

J Natl Compr Canc Netw

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140

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Treatment of acute lymphoblastic leukemia (ALL) continues to advance, as evidenced by the improved risk stratification of patients and development of newer treatment options. Identification of ALL subtypes based on immunophenotyping and cytogenetic and molecular markers has resulted in the inclusion of Philadelphia-like ALL and early T-cell precursor ALL as subtypes that affect prognosis. Identification of Ikaros mutations has also emerged as a prognostic factor. In addition to improved prognostication, treatment options for patients with ALL have expanded, particularly with regard to relapsed/refractory ALL. Continued development of second-generation tyrosine kinase inhibitors and the emergence of immunotherapy, including blinatumomab and chimeric antigen receptor T-cell therapy, have improved survival. Furthermore, incorporation of minimal residual disease (MRD) monitoring has shown insight into patient outcomes and may lead to treatment modification or alternative treatment strategies in select populations. This excerpt focuses on the sections of the ALL guidelines specific to clinical presentation and diagnosis, treatment of relapsed/refractory ALL, and incorporation of MRD monitoring. To view the most recent complete version of these guidelines, visit NCCN.org. (J Natl Compr Canc Netw 2015;13:1240-1279 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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“…153 A recent phase II study from MDACC evaluated an augmented hyper-CVAD regimen (that incorporated asparaginase, intensified vincristine, and intensified dexamethasone) as salvage therapy in adults with relapsed/refractory ALL (N = 90; median age, 34 years; range, 14-70 years; median 1 prior regimen). 154 Among evaluable patients (n = 88), the CR rate was 47%; an additional 13% experienced a CRp and 5% a partial remission. The 30-day mortality rate was 9%, and was lower among the subgroup who received polyethylene glycol (PEG)-asparaginase than those who received L-asparaginase (1% vs. 12%).…”

Section: Treatment Of Relapsed Ph-negative Allmentioning

confidence: 99%

“…In this study, 32% of patients were able to proceed to HSCT. 154 Nelarabine is a nucleoside analog that is currently approved for the treatment of patients with T-cell ALL who have not experienced response to or have relapsed after at least 2 chemotherapy regimens. 135 A phase II study of nelarabine monotherapy in children and adolescents with relapsed/refractory T-cell ALL or T-cell non-Hodgkin lymphoma (N = 121) showed a 55% response rate among the subgroup with T-cell ALL with first bone marrow relapse (n = 34) and a 27% response rate in the subgroup with a second or greater bone marrow relapse (n = 36).…”

Section: Treatment Of Relapsed Ph-negative Allmentioning

confidence: 99%

Acute Lymphoblastic Leukemia

Alvarnas

Brown

Aoun

et al. 2012

J Natl Compr Canc Netw

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The inaugural NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for acute lymphoblastic leukemia (ALL) were developed as a result of meetings convened by a multidisciplinary panel of experts in 2011. These NCCN Guidelines provide recommendations on the diagnostic evaluation and workup for ALL, risk assessment, risk-stratified treatment approaches based on the Philadelphia chromosome status and age (adults vs. adolescents/young adults), assessment of minimal residual disease, and supportive care considerations. It is recommended that patients be treated at specialized centers with expertise in the management of ALL. (JNCCN 2012;10:858-914) NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Augmented Hyper-CVAD Based on Dose-Intensified Vincristine, Dexamethasone, and Asparaginase in Adult Acute Lymphoblastic Leukemia Salvage Therapy

Cited by 59 publications

References 16 publications

Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia

Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia

Acute Lymphoblastic Leukemia, Version 2.2015

Acute Lymphoblastic Leukemia

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