Effectiveness of modified hyper‐CVAD chemotherapy regimen in the treatment of adult acute lymphoblastic leukemia: a retrospective experience

• Published in: Cancer medicine (Malden, MA) Vol. 7; no. 3; pp. 594 - 599
• Main Authors: Jalaeikhoo, Hasan, Rajaeinejad, Mohsen, Keyhani, Manoutchehr, Zokaasadi, Mohammad, Dehghani Firoozabadi, Mohammad Mehdi
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2018; John Wiley and Sons Inc; Wiley
• Subjects: Acute lymphoblastic leukemia; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - pharmacology; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Clinical Cancer Research; Cyclophosphamide; Cyclophosphamide - pharmacology; Cyclophosphamide - therapeutic use; Cytarabine; Daunorubicin; Dexamethasone - pharmacology; Dexamethasone - therapeutic use; Doxorubicin; Doxorubicin - pharmacology; Doxorubicin - therapeutic use; Female; Humans; Leukemia; Lymphatic leukemia; Male; Medical records; Methotrexate; Middle Aged; modified Hyper‐CVAD; Original Research; Patients; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Prednisolone; Remission; Retrospective Studies; Survival Analysis; Vincristine; Vincristine - pharmacology; Vincristine - therapeutic use; Young Adult; Acute lymphoblastic leukemia; survival analysis; modified Hyper-CVAD
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.1328

Several chemotherapy regimens have been developed for the treatment of acute lymphoblastic leukemia (ALL), but relapse still presents the most common obstacles to attaining long‐term survival. The hyper‐CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and prednisolone)/HD MTX and Ara‐C (high‐dose methotrexate and cytarabine) chemotherapy regimen was first started in the MD Anderson Cancer Center as an intensive regimen for adult patients with ALL. The purpose of this study was to evaluate the effectiveness of a modified hyper‐CVAD protocol. We used hyper‐CVAD as consolidation/maintenance after remission induction with daunorubicin, vincristine, and prednisolone (and cyclophosphamide for T‐cell ALL only) rather than standard hyper‐CVAD in order to reduce treatment complications. This study was conducted as a retrospective review of medical records of ALL patients at 501 army hospital, Tehran, Iran, from 2005 to 2015. Three hundred and one patients underwent modified hyper‐CVAD chemotherapy regimen. Complete remission and overall survival (OS) rates were measured as primary endpoints. Two hundred and forty‐six (81.7%) reached complete remission (CR) during the first 6 months of treatment, and 55 patients (18.3%) did not reach CR. The 5‐year OS rate was 51.8% (95% CI (confidence interval): 45.1–57.8%). Modified hyper‐CVAD regimen is an efficient intensive chemotherapy regimen for consolidation/maintenance of adults with newly diagnosed ALL and has an acceptable 5‐year overall that is comparable to standard hyper‐CVAD regimen. We used a modified hyper‐CVAD protocol to reduce treatment‐related mortality and simultaneously reach an acceptable overall survival in patients with adult ALL. The results were promising, and it seems that this protocol could be of great benefit for ALL patients.