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

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.