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An asparaginase-based pediatric-inspired chemotherapy regimen: outcomes for older patients with Ph- ALL

Jul 9, 2024
Learning objective: After reading this article, learners will be able to cite a new clinical development in ALL.

Results from a retrospective analysis evaluating outcomes in older patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph-ALL) treated with a pediatric-inspired protocol have been published in Hematology by Perusini et al.1 The analysis included 73 patients aged ≥ 60 years treated with a modified pediatric-inspired chemotherapy regimen incorporating either pegylated asparaginase (PEG-ASP) or native ASP (EC-ASP) between January 2002 and January 2022.

Key learnings

In older patients receiving a modified pediatric-inspired chemotherapy regimen including PEG-ASP or EC-ASP, 61% of patients experienced Grade III-IV adverse events (AEs); the most prevalent AEs were thrombosis (35.6%), febrile neutropenia (38.4%), and transaminitis (34.2%). 

Median overall survival (OS) was 54 months (95% confidence interval (CI), > 23.7), and the leukemia-free (LFS) survival at 4 years was 48% (95% CI, 33.7–60.6). 

The type of ASP was not significantly associated with OS, LFS or early mortality, but AEs were higher with PEG-ASP vs EC-ASP; male sex and high PEG-ASP dose were identified as significant independent factors for thrombotic events. 

Older age ( 70 years), increased white blood cell count at presentation, previous diagnosis of malignancy, and positive measurable residual disease status post-induction therapy were found to be significantly associated with worse OS. 

An ASP-centered pediatric-inspired chemotherapy protocol can be an effective and well-tolerated therapeutic option for older patients with Ph- ALL when used alongside with diligent monitoring and follow-up. 

  1. Perusini MA, Andrews C, Atenafu EG., et al. Outcomes and adverse events in older acute lymphoblastic leukemia patients treated with a pediatric-inspired protocol with pegylated or native asparaginase. Hematology. 2024:29(1). DOI: 10.1080/16078454.2024.2329027


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