Retrospective study of Dana Farber Consortium Protocol in newly diagnosed Egyptian adolescents and young adults with acute lymphoblastic leukemia: Tanta experience

Abstract

Background Intensive acute lymphoblastic leukemia (ALL) regimens in children improve the 5-year event-free survival (EFS) to reach ~ 90%. Adolescents and young adults (AYA) have EFS (30% to 45%). Young AYA ALL patients treated with pediatric chemotherapy protocols such as Dana Farber Consortium Protocol (DFCP) experience a better prognosis. This study aimed to assess the efficacy [EFS and overall survival (OS)] and the toxicity of DFCP in the treatment of Egyptian AYA with newly diagnosed ALL. A retrospective study was performed on 41 patients with newly diagnosed ALL (15 and 39 years) who were treated with DFCP. EFS and OS were estimated using the Kaplan-Meier method. Results Thirty-eight patients (92.68%) achieved complete remission (CR). Eleven patients (26.83%) relapsed. Ten (24.39%) patients died. One, two, and three years of EFS were 75.61%, 72.91%, and 67.51% respectively. One, two, and three years OS were 85.3%, 77.26%, and 74.39% respectively. Neutropenia was the most common adverse event observed in 100% of patients. Conclusion DFCP can be considered as an effective ALL protocol for the AYA group of patients with good CR, EFS, and OS rates. DFCP seemed to be feasible in AYA despite the toxicities experienced.

The Effect of Chemotherapy Induction Therapy on the Pancreas in Patients with Acute Lymphoblastic Leukemia

“…In our study, no patients had chemotherapy drug-induced acute pancreatitis. This finding contradicts prior studies from other countries [11][12][13][14][15], which found acute pancreatitis despite its rarity. The differences between the present finding and the prior studies may be due to sampling size, the health status of patients, standard care of hospitals, the type of chemotherapy drug regimen, and short-term follow-up.…”

“…These findings indicated that children receiving chemotherapy drugs were more toxic and susceptible to pancreatitis than adults. The evidence is consistent with earlier findings [ 15 – 19 ]. Children's mean amylase and lipase enzyme levels increased as chemotherapy drug dosages increased from baseline to 4-week induction.…”

“…In Egypt, 7.31% of patients who received the pediatric DFCP regimen developed acute pancreatitis. Adolescents and young adults were more toxic than children [ 15 ]. Patients aged 10 to 18 years were more likely to experience asparaginase-related pancreatitis than those younger than 10 years [ 16 , 17 ].…”

Evaluation of liver function tests to identify hepatotoxicity among acute lymphoblastic leukemia patients who are receiving chemotherapy induction

“…The mild drug-induced liver injury occurred in 5% of patients. The incidence of hepatotoxicity in this study is higher than in a prior studies in Egypt 21 and Singapore 18 but lower than in studies in the United States 19 and the Netherlands 20 for patients who received L-asparaginase as a chemotherapy induction. The difference could be attributed to the administration of four chemotherapy drugs in the current study, variations in hepatotoxicity grading criteria, the health status of patients, standard care of hospitals, and sample size.…”

“…Hepatotoxicity occurred in 9.76% of patients treated with the Dana Farber Consortium Protocol (DFCP) in Egypt. Adolescents and young adults had favorable outcomes with DFCP but more toxicity 21 . Greater asparaginase activity levels resulted in statistically significant increases in ALT and bilirubin 22 .…”