1. Treatment of Ph-Negative Acute Lymphoblastic Leukemia in Adolescents and Young Adults with an Affordable Outpatient Pediatric Regimen
- Author
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Andrés Gómez-De León, Ana L. Varela-Constantino, Perla R. Colunga-Pedraza, Alexia Sánchez-Arteaga, Valeria García-Zárate, Anna Cecilia Rodríguez-Zúñiga, Nereida Méndez-Ramírez, Olga G. Cantú-Rodríguez, César H. Gutiérrez-Aguirre, Luz Tarín-Arzaga, Elías E. González-López, José Carlos Jaime-Pérez, and David Gómez-Almaguer
- Subjects
Cancer Research ,Neoplasm, Residual ,Adolescent ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Prognosis ,Disease-Free Survival ,Young Adult ,Treatment Outcome ,Oncology ,Outpatients ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Asparaginase - Abstract
B-cell acute lymphoblastic leukemia is frequent in Hispanic adolescents and young adults. Outcomes of implementation of pediatric-inspired regimens in low-and middle-income countries are not well known.In this study we treated 94 adolescents and young adults with a local BFM regimen designed to be affordable with the use of native L-asparaginase and mitoxantrone administered in an outpatient fashion, and the of BCR/ABL and measurable residual disease (MRD) determined by high sensitivity flow cytometry for risk stratification.Induction mortality was 11%; 25% of patients had to abandon treatment or be transferred to another health system. Two-year overall (OS) and event free survival (EFS) were 61.5% and 49.8%, MRD-negative patients had a 24-month OS of 85.6% vs. 69.6% (p = .024) and EFS of 76% vs. 45.5% (p = .004). Patients older than 40 years and those who abandoned treatment had worse EFS. Overall drug costs in our regimen were 52% lower than those of CALGB10403. The treatment of AYAs with ALL with an outpatient focus was implemented successfully at a reduced cost. Genetic risk assessment, treatment abandonment and lack of access to novel therapies remain major barriers for improving outcomes.
- Published
- 2022
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