Effectiveness of modified hyper‐CVAD chemotherapy regimen in the treatment of adult acute lymphoblastic leukemia: a retrospective experience

Abstract

Several chemotherapy regimens have been developed for the treatment of acute lymphoblastic leukemia (ALL), but relapse still presents the most common obstacles to attaining long‐term survival. The hyper‐CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and prednisolone)/HD MTX and Ara‐C (high‐dose methotrexate and cytarabine) chemotherapy regimen was first started in the MD Anderson Cancer Center as an intensive regimen for adult patients with ALL. The purpose of this study was to evaluate the effectiveness of a modified hyper‐CVAD protocol. We used hyper‐CVAD as consolidation/maintenance after remission induction with daunorubicin, vincristine, and prednisolone (and cyclophosphamide for T‐cell ALL only) rather than standard hyper‐CVAD in order to reduce treatment complications. This study was conducted as a retrospective review of medical records of ALL patients at 501 army hospital, Tehran, Iran, from 2005 to 2015. Three hundred and one patients underwent modified hyper‐CVAD chemotherapy regimen. Complete remission and overall survival (OS) rates were measured as primary endpoints. Two hundred and forty‐six (81.7%) reached complete remission (CR) during the first 6 months of treatment, and 55 patients (18.3%) did not reach CR. The 5‐year OS rate was 51.8% (95% CI (confidence interval): 45.1–57.8%). Modified hyper‐CVAD regimen is an efficient intensive chemotherapy regimen for consolidation/maintenance of adults with newly diagnosed ALL and has an acceptable 5‐year overall that is comparable to standard hyper‐CVAD regimen.

Prognostic Factors and Outcome of Patients with Adult Acute Lymphoblastic Leukemia Treated with the Hyper-CVAD Regimen: A Retrospective Study

“…However, according to novel therapeutics efciency, the outcome of the Hyper-CVAD regimen is no longer satisfying and overall survival is poor. Our observations indicated that 59 out of the total patients (84.2%) achieved CR, which is consistent with the fndings of the Buyukasik (84.2%) [7] and the Mehrzad (84%) [8] studies, higher than that reported in the Jalaeikhoo et al (81.7%) [6] and Xu et al (73.6%) [9] studies. However, our study's CR rate was lower than most studies, with CR rates higher than 90% [1, 3-5, 10, 11].…”

“…Despite novel therapies developed for ALL, the outcome of patients in Iran is still disappointing and has not changed signifcantly over the last decades. Tis condition may be due to the poor survival of adult ALL patients, relapses without apparent reason, and high treatment costs even in the remission period [6]. More intensive chemotherapy regimens have been shown to have a better outcome in adult ALL patients.…”

Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia

“…Various chemotherapy regimens were used for the treatment of haematological malignancy at DGMAH with Hyper-CVAD found to be the most used regimen. Jalaeikhoo et al ( 2018 ) also reported that the Hyper-CVAD regimen is widely used. However, Verburgh and Antel ( 2019 ) recommended that Hyper-CVAD should only be prescribed for high-grade or highly aggressive lymphoma.…”