When should a Hyper CVAD regimen be considered for ALL? And when not?

During the Society of Hematologic Oncology (SOHO) 2021 Annual Meeting, the ALL Hub spoke to Elias Jabbour, MD Anderson Cancer Center, Houston, US. We asked, When should a hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone, alternated with methotrexate and cytarabine (hyper-CVAD) regimen be considered for ALL? And when not?

Jabbour begins by outlining how this pediatric inspired regimen became a standard of care. He goes on to explain how by monitoring toxicities, disease and patient profiles, adjustments can be made, e.g. dose variations or drug omissions. He highlights that future treatment is moving away from intensive chemotherapy in favor of further integration of immunotherapy into the regimen.