Comparative study between Results of Classic (old) and Childhood Inspired Chemotherapy Protocols in Treatment of Adult Acute Lymphoblastic Leukaemia

Abstract

ALL is a disease of uncontrolled division of malignant lymphoid progenitor cells within the bone marrow, blood and extra-medullary sites. The incidence of ALL in the US is 1.7 per 100,000 persons a year, with the most frequent diagnosis among pediatrics. ALL is has a poor prognosis in adults due to the high rates of relapses, refractoriness and treatment-related toxicities. Despite a high rate of remission by induction chemotherapy, only 30–40% of ALL adults will achieve long-term remission. Objectives: Our study aim was to to compare the results of childhood inspired chemotherapeutic protocols and adult protocols in the treatment of adult acute lymphoblastic leukemia regarding response rate, overall survival, progression-free survival and relapse rate (single center experience). Results: The 5-year OS for DFCI was 66.7 % and 71.1% for Holzer’s protocol The difference between survival functions was not statistically significant . Similarly, the 5-year DFS for DFCI was 59.3 % and 63.4% for Holzer’s . Again, there was no statistically significant difference between the survival function for both groups protocols. Most common complications were pneumonia, peripheral neuropathy, pancreatitis, venous thrombosis, seizures and mucormycosis but there was no statistically significant difference between both groups. The main death causes were relapse, sepsis and intracranial hemorrhage. Again, there was no statistically significant difference between both groups. Conclusion: The findings of this study show that the pediatric-inspired regimen may be considered for adult ALL. Survival disparities between adults with ALL treated in pediatric vs adult centers have persisted over time, partially attributable to incomplete adoption of pediatric protocols by adult centers. Although pediatric protocol use has improved survival, residual disparities remain, perhaps due to other differences in care between adult and pediatric centers.