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2018, Number 1

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Rev Hematol Mex 2018; 19 (1)

Efficacy of a dynamic and “adult inspired” treatment for the reduction of early relapse in adult patients with acute lymphoblastic leukemia

Ramos-Peñafiel C, Castellanos-Sinco H, Olarte-Carrillo I, Santoyo-Sánchez A, Rozen-Fuller E, León-González G, Kassack-Ipiña JJ, Montaño-Figueroa E, Collazo-Jaloma J, Martínez-Tovar A

Language: Spanish
References: 43
Page: 5-16
PDF size: 504.74 Kb.


ABSTRACT

Background: The improvement of the adult acute lymphoblastic leukemia treatment has allowed identifying that young patients (under 39 years) benefit from being treated by intensive treatment protocols.
Objectivo: To identify the efficacy on relapse of a protocol inspired by the main schemes used for lymphoid neoplasms, contrasting it with the historical record.
Material and Method: A retrospective, observational study was done in adult patients with acute lymphoblastic leukemia treated with an adult inspired intensive treatment and modifiable according to the MRD status (HGMLAL1). The results were compared with the historical record (HGML07).
Results: Of the 340 patients studied, 75 were treated according to the new intensive treatment (HGMLAL13) and 265 cases with the historical record (57.4%). The average age was 32 years (16-79 years), and mostly high-risk patients (62.7%, n = 11). The expression of the BCRABL1 oncogene was registered in 3.2% of the cases. The frequency of relapses to bone marrow was lower in the intensive protocol compared to the historical cohort (21.3 vs 45.3%), isolated relapse to the central nervous system was similar in the two protocols (2.7 vs 1.9%). The persistence of a positive minimal residual disease at any stage of treatment (week 12, 24 or 36) was associated with an increase in the risk of relapse (OR: 2.05, 2.00 and 5.66, respectively). Finally, intensive treatment behaved as a protective factor against relapse (OR: 0.3604).
Conclusion: The implementation of intensive and modifiable schemes according to the level of expression of the minimal residual disease is useful for the treatment of adult acute lymphoblastic leukemia.


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