Final results of a single institution experience with a pediatric‐based regimen, the augmented Berlin–Frankfurt–Münster, in adolescents and young adults with acute lymphoblastic leukemia, and comparison to the hyper‐CVAD regimen

Abstract

Several studies reported improved outcomes of adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated with pediatric‐based ALL regimens. This prompted the prospective investigation of a pediatric Augmented Berlin–Frankfurt–Münster (ABFM) regimen, and its comparison with hyper‐fractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone (hyper‐CVAD) in AYA patients. One hundred and six AYA patients (median age 22 years) with Philadelphia chromosome‐ (Ph) negative ALL received ABFM from October 2006 through March 2014. Their outcome was compared to 102 AYA patients (median age 27 years), treated with hyper‐CVAD at our institution. The complete remission (CR) rate was 93% with ABFM and 98% with hyper‐CVAD. The 5‐year complete remission duration (CRD) were 53 and 55%, respectively (P = 0.98). The 5‐year overall survival (OS) rates were 60 and 60%, respectively. The MRD status on Day 29 and Day 84 of therapy was predictive of long‐term outcomes on both ABFM and hyper‐CVAD. Severe regimen toxicities with ABFM included hepatotoxicity in 41%, pancreatitis in 11%, osteonecrosis in 9%, and thrombosis in 19%. Myelosuppression‐associated complications were most significant with hyper‐CVAD. In summary, ABFM and hyper‐CVAD resulted in similar efficacy outcomes, but were associated with different toxicity profiles, asparaginase‐related with ABFM and myelosuppression‐related with hyper‐CVAD. Am. J. Hematol. 91:819–823, 2016.