Outcome of adult acute lymphoblastic leukemia with BFM protocol in a resource-constrained setting

Abstract

Cure rates for adult acute lymphoblastic leukemia (ALL) in developing countries are significantly lower because of problems unique to these countries. We assessed some of the problems in adult ALL patients (>12 years of age) in a tertiary care hospital of northwest India with modified BFM regimen. The diagnosis of ALL was made according to FAB criteria. The protocol consisted of Phase I & II induction, consolidation, reinduction and maintenance phases. CNS prophylaxis was administered with 24 Gy radiation and intrathecal methotrexate. One hundred and eighteen patients (72.9% males), aged 12-68 years (median 23 years) were treated from January 1997 till December 2003. Follow-up of patients was done till December 2005. Complete remission (CR) was achieved in 85.6% patients after induction therapy and 40% patient relapsed. Most patients (23.7%) relapsed during the maintenance phase or after completion of chemotherapy. At least 15% of patients (15/101) after successful induction abandoned the treatment because of financial constraints, prolonged travel time to treatment facility and switching over to alternative medicines. Fatal infectious complications occurred in 19.5% of patients. The 3-year and 5-year event free survival rates were 29.8% and 21.6% respectively. In conclusion, modified BFM regimen resulted in high induction rates but relatively poor 5-year event free survival. Infections related death and post induction abandonment of treatment were the main reasons for poor overall results.

Prevalence and predictors of abandonment of therapy among children with cancer in El Salvador

“…The continued effect of socioeconomic status may represent the inability to absorb opportunity costs ( e.g ., income lost due to clinic visits). Alternatively, low socioeconomic status may be a proxy for poor understanding of either the seriousness of the condition or the potential curability of many childhood cancers, as noted by others 12…”

Compliance With Neoadjuvant Chemotherapy in T4 Oral Cancers: Place, Person, Socioeconomic Status, or Assistance

“… 7 , 21 The reported incidence of noncompliance with management of adult hematologic malignancies has also varied from 16% to 71%. 22 , 23 Similarly, the no compliance rate for pediatric solid tumor treatment in India is alarmingly high, ranging from 10% to 62% in different cancer centers across the country. 24 Noncompliance rates in other developing countries in Asia, central America, and Africa for pediatric solid tumor treatment have ranged from 4% to 67%, 1% to 41%, and 4% to 50%, respectively.…”

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

“…In general, the pediatric population tolerates chemotherapy better than adults and experiences improved outcomes when compared to adults on the same regimen [7,8,9]. The data available in terms of tolerability and efficacy of BFM chemotherapy in adults are limited [10,11]. …”

“…The BFM chemotherapy regimen has proven efficacious in pediatric and young adult patients [7,8,9]. Based on the promising data for pediatric ALL cases, BFM-like regimens began to be used in the adult population [10,11]. In the study of Chang et al [11], OS at 5 years was reported as 62% with the BFM protocol.…”