Is the BFM Regimen Feasible for the Treatment of Adult Acute Lymphoblastic Leukemia? A Retrospective Analysis of the Outcomes of BFM and Hyper-CVAD Chemotherapy in Two Centers

Alacacıoğlu, İnci; Medeni, Şerife Solmaz; Özsan, Güner Hayri; Payzın, Bahriye; Sevindik, Omur Gokmen; Acar, Celal; Abdullah, Khaizuran; Ozdemirkan, Fusun; Ozden, Piskin; Özcan, Mehmet Ali; Ündar, Bülent; Demırkan, Fatih

doi:10.1159/000375258

Cited by 23 publications

(30 citation statements)

References 13 publications

(22 reference statements)

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“…This study had limitations as a result of its retrospective nature, small numbers, and a selection bias for different treatment regimens. 17 However, similar to the report by Buyukasik et al, 9 Alacacioglu et al 14 also reported a superior 5-year OS rate using a Berlin-Frankfurt-Münster regimen (n = 20) compared with the more intensive HCVAD regimen (n = 30; 59% v 34%, respectively). A common theme in these reports was the significant challenge in intensifying the chemotherapy regimens in adult patients with ALL in a developing country.…”

Section: Introductionsupporting

confidence: 64%

Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country

Jain

Korula

Deshpande

et al. 2018

JGO

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Purpose Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our center were analyzed. Standard-risk (SR) patients were offered treatment with a modified German Multicenter ALL (GMALL) regimen, whereas high-risk (HR) patients were offered intensification of therapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD). Because of resource constraints, a proportion of HR patients opted to receive the same treatment regimen as used for SR patients. Results There were 344 SR patients (67.8%) and 163 HR patients (32.2%) at diagnosis. Among the HR patients, 53 (32.5%) opted to receive intensification with the HCVAD regimen. The SR cohort showed a superior 5-year event-free survival rate compared with the HR cohort (47.3% v 23.6%, respectively; P < .001). Within the HR subgroup, there was no statistically significant difference in overall survival or event-free survival between patients who received the modified GMALL regimen (n = 59) and patients who received HCVAD (n = 53). Conclusion Intensified therapy in the HR subset was associated with a significant increase in early treatment-related mortality and cost of treatment. A modified GMALL regimen was found to be cost-effective with clinical outcomes comparable to those achieved with more intensive regimens.

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Section: Introductionsupporting

confidence: 64%

Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country

Jain

Korula

Deshpande

et al. 2018

JGO

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“…However, a lower 5-year OS rate was seen in patients treated on hyper-CVAD compared with CALGB-8811 (26% vs. 44%, respectively). Similarly, a recent report from Alacacioglu et al 62 found similar CR rates after induction therapy for patients treated with BFM or hyper-CVAD protocols (95% and 96%, respectively). However, patients in the BFM group showed higher 5-year survival rates compared with the hyper-CVAD group (59% vs. 34%, respectively).…”

Section: Treatment Of Aya Patients With Allsupporting

confidence: 53%

Best Practices in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia: A Focus on Asparaginase

Boissel

Sender

2015

Journal of Adolescent and Young Adult Oncology

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The inclusion of asparaginase in chemotherapy regimens to treat acute lymphoblastic leukemia (ALL) has had a positive impact on survival in pediatric patients. Historically, asparaginase has been excluded from most treatment protocols for adolescent and young adult (AYA) patients because of perceived toxicity in this population, and this is believed to have contributed to poorer outcomes in these patients. However, retrospective analyses over the past 12 years have shown that 2-, 5-, and 7-year overall survival of AYA patients is significantly improved with pediatric versus adult protocols. The addition of asparaginase to adult protocols yielded high rates of first remission and improved survival. However, long-term survival remains lower compared with what has been seen in pediatrics. The notion that asparaginase is poorly tolerated by AYA patients has been challenged in multiple studies. In some, but not all, studies, the incidences of hepatic and pancreatic toxicities were higher in AYA patients, whereas the rates of hypersensitivity reactions did not appear to differ with age. There is an increased risk of venous thromboembolic events, and management with anti-coagulation therapy is recommended. Overall, the risk of therapy-related mortality is low. Together, this suggests that high-intensity pediatric protocols offer an effective and tolerable approach to treating ALL in the AYA population.

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“…There was no difference between two protocols in terms of adverse effects. 12 In our present study, BFM-95 was better than Hyper-CVAD as well.…”

Section: Discussionsupporting

confidence: 61%

Pediatric Chemotherapeutic Regimen (BFM-95) is Superior for Overall Survival in Adult Acute Lymphoblastic Leukemia

Malkan¹

2018

UHOD

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Acute lymphoblastic leukemia (ALL) is a neoplastic disease characterized by clonal malignant proliferation of the lymphoid blast cells. The aim of this study is to compare chemotherapy, pediatric regimen BFM-95 protocol with adult ALL protocols in our patient cohort. We retrospectively collected data of patients aged 17 and older who were registered to database of our Hematology Department as acute lymphocytic leukemia between the years 2003-2016. Demographic data,chemotherapy protocols,side effects due to chemotherapy,disease free survivals (DFS) and overall survivals(OS) of remaining 101 patients were compared. The mean age of the patients was 33.6±14.5 ages.80% of patients were BALL ,15% were TALL , 5% were in Ph+ ALL phenotype.Coagulopathy was seen more in patients receiving BFM-95 (p= 0.002). There was no significant difference among the protocols except for the coagulopathy. The complete remission rate (CR) was 100% in the BFM-95 protocol group, 70% in the Hyper-CVAD group and 60% in the CALGB receiving group. Three-year OS rate was 89% in patients receiving BFM-95, 41% in patients receiving Hyper-CVAD and 53% in CALGB group (p= 0.022).Since patients receiving BFM-95 are under 40 years of age, in order to be able to evaluate the BFM-95 protocol more clearly, OS is examined separately in patients under 40 years of age and it was found that OS was again significantly high in BFM-95 group (p= 0.014). The BFM-95 protocol has been shown to be well tolerated and to improve survival in adult patients when careful in terms of L-asparaginase and steroid-dependent side effects.

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Is the BFM Regimen Feasible for the Treatment of Adult Acute Lymphoblastic Leukemia? A Retrospective Analysis of the Outcomes of BFM and Hyper-CVAD Chemotherapy in Two Centers

Cited by 23 publications

References 13 publications

Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country

Adult Acute Lymphoblastic Leukemia: Limitations of Intensification of Therapy in a Developing Country

Best Practices in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia: A Focus on Asparaginase

Pediatric Chemotherapeutic Regimen (BFM-95) is Superior for Overall Survival in Adult Acute Lymphoblastic Leukemia

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