High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden
Hyper-CVAD is widely used to treat acute lymphoblastic leukemia (ALL) and aggressive lymphomas. This multicenter, population-based study assessed the efficacy of Hyper-CVAD as first line therapy in patients with T cell ALL (T-ALL).
Between October 2002 and September 2006, 24 patients were diagnosed with T-ALL in Sweden; 19 were eligible for treatment with the protocol.
The median age was 32 years (range 18-72 years). Complete remission (CR) was obtained in 17/19 (89%) patients, and the treatment was relatively well tolerated. Allogeneic stem cell transplantation (SCT) was recommended in high-risk disease and was performed in four patients upfront. Two and 5-year leukemia-free survivals (LFS) in 17 patients with CR achievement were identical, at 29% (95% confidence interval [CI]: 8-51). Two and 5-year overall survival (OS) in whole cohort were 63% (95% CI: 42-85) and 47% (95% CI: 26-69), respectively. The 5-year LFS for 15 patients who did not receive allogeneic SCT upfront was 20% (95%CI: 0-40), although 14/15 completed the protocol (eight cycles). Relapse occurred in 2/4 upfront-transplanted patients and in 12/15 patients treated with chemotherapy alone, six of whom received allogeneic SCT in CR2. Age ≥ 35 years influenced OS negatively in univariate analysis (HR 5.1, 95% CI: 1.55-16.7).
Hyper-CVAD treatment resulted in a high CR rate and appeared safe, but it showed poor efficacy at preventing relapse. Therefore, this treatment is no longer recommended for adults with T-ALL in Sweden. This article is protected by copyright. All rights reserved.
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