scholarly journals The Impact of Obesity on the Outcomes of Adult Patients with Acute Lymphoblastic Leukemia – A Single Center Retrospective Study

2021 ◽  
Vol Volume 11 ◽  
pp. 1-9
Author(s):  
Qiuju Liu ◽  
Brittny Major ◽  
Jennifer Le-Rademacher ◽  
Aref A Al-Kali ◽  
Hassan Alkhateeb ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
Single Center ◽  
The Impact

A Single-Center Retrospective Analysis of a Pediatric Salvage Chemotherapy Regimen for Adults with Relapsed/Refractory Acute Lymphoblastic Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4919-4919
Author(s):  
Ben A. Blomberg ◽  
Hendrik W. Van Deventer ◽  
Stuart Gold ◽  
Katarzyna Joanna Jamieson ◽  
Joshua F. Zeidner ◽  
...  
Keyword(s):  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Salvage Chemotherapy ◽  
Adult Patients ◽  
Intrathecal Methotrexate ◽  
Cell Transplant ◽  
Single Center ◽  
Hematopoietic Stem

Abstract Background: Relapsed or refractory acute lymphoblastic leukemia (ALL) remains challenging to treat with an extremely poor prognosis. Salvage chemotherapy regimens can achieve complete remission (CR) rates of 30-50%, but CRs are not durable without hematopoietic stem cell transplant (HSCT). Outcomes in untreated adolescents and young adults have improved with the use of pediatric chemotherapy regimens, but data on the use of pediatric chemotherapy regimens in relapsed/refractory adult ALL is lacking. We chose to retrospectively examine the outcomes of adult patients with relapsed ALL at our institution treated with the CCG-1941 pediatric salvage protocol (Gaynon PS, et al. J Clin Oncol 2006). Methods: We conducted a single-center retrospective cohort study of patients aged 18 and older with relapsed/refractory ALL who were treated with the CCG-1941 protocol. Patients received induction with vincristine, dexamethasone, ifosfamide, etoposide, PEG-asparaginase, and methotrexate, as well as intrathecal methotrexate, cytarabine, and hydrocortisone prophylaxis, followed by intensification and continuation phases. This regimen was offered to relapsed/refractory patients who, in the judgement of treating physician, were likely to tolerate multiagent chemotherapy. All adult patients who received this regimen between 2006 and 2015 were included in the analysis. Outcomes of interest were: the CR rate, duration of remission (DOR), toxicity, 30-day mortality, and the rate of patients undergoing HSCT. Results: Between January 2006 and April 2015, 15 patients aged 20-54 (median 31) with first relapse (n=12) or refractory (n=3) ALL were treated with the CCG-1941 regimen. Baseline patient characteristics are described in the Table 1. Seven patients (47%) had alterations to the induction protocol. The majority of these modifications were reduction or omission of PEG-asparaginase or vincristine. All patients experienced infectious complications, most commonly neutropenic fever (n= 12, 80%, 95% CI 52-96). There was one death due to infection, which occurred during an intensification phase. Two patients had grade 3 pancreatitis and two patients had hemorrhage (one grade 2, and one grade 5). 30-day mortality was 7% (95% CI 0-32) due to one fatal intracranial hemorrhage. Median length of hospitalization for induction was 28 days (range 10-61). Twelve patients (80%, 95% CI 52-96) achieved CR, and six of these patients received 1-2 cycles of intensification or continuation. Among the remaining 6 CR patients, one proceeded immediately to HSCT, two received other consolidation, two had early relapse, and one was lost to follow up. Six patients proceeded directly to HSCT, and one more underwent HSCT after receiving subsequent therapies for relapsed disease. The DOR was 81% at 6 months, 54% at 12 months, 36% at 18+ months and 18% at 24 months. One patient has been followed for 63 months and has not recurred. Median follow-up for survivors was 16 months (range 3.6-63). Conclusions: The CCG-1941 regimen appears to be tolerable and efficacious in adult patients with relapsed/refractory ALL. This regimen has been previously reported only in children. Despite the regimen's toxicities, a substantial proportion of patients underwent subsequent stem cell transplantation. Such salvage therapies remain important options for patients with T-ALL and for those B-ALL patients who are not candidates for, or who have failed phenotype-specific immunotherapies. Further prospective, multicenter study is warranted for use of pediatric salvage regimens in the adult patient population. Disclosures Foster: Celgene: Research Funding.

scholarly journals Risk Factors for Induction Related Mortality in Adults Patients with Acute Lymphoblastic Leukemia: Report from a Hispanic Population

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5162-5162
Author(s):  
Sergio I Inclan-Alarcon ◽  
Christianne Bourlon ◽  
Oscar Manuel Fierro-Angulo ◽  
Jesus A Garcia-Ramos ◽  
Santiago Riviello-Goya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Adult Patients ◽  
Hispanic Population ◽  
Increased Risk ◽  
The Impact ◽  
Hispanic Adult

Abstract Introduction Acute lymphoblastic leukemia (ALL) represents 20-30% of acute leukemia in adults. Higher incidence and inferior outcomes in Hispanic population have been described. In Latin Americans induction mortality (IM) is a major cause of death representing 20-50% vs.7-11% in developed countries. Our aim was to determine risk factors (RF) related to IM in ALL Hispanic adult patients. Methods We retrospectively analyzed clinical data of ≥18yo patients with ALL diagnosed and treated at our institution within 2009 and 2016. Results A total of 170 patients were included. Median age was 29 years (16-70), 64% were AYA, 96.8% had B-cell ALL, and 62.3% received Hyper-CVAD. IM rate was 13.4%. In 64.1% IM was related to an infectious cause. The most frequent infection was pneumonia (39.8%). Gram-negative etiology was more prevalent (35.5% vs. 10.2%), however, IM rate was higher in gram-positive infections (26.3% vs .13.6%; p=.028). RF related to IM in univariate analysis were: CNS involvement (OR4.6,95%IC2.8-9.5;p=<.001), tumor lysis syndrome (TLS) (OR 5.6, 95% CI 2.2-14.1; p=<.001), need for dialysis (OR 28.9, 95% CI 5.3-157.1; p=<.001), primary hypertension (OR 3.5, 95% CI 1.0-12.7; p=.052), shock status (OR 10.3, 95% CI 3.9-27.3; p=<.001), ECOG³2 (OR 1.9, 95% IC 1.1-3.4; p=.022), T-ALL (OR 2.2, 95% IC 1.1-4.3; p=.026), Hyper-CVAD (OR 1.9, 95% IC 1.1-3.8; p=0.51), ventilation assistance (OR 7.7, 95% IC 2.8-21; p=<.001), and vasopressor use (OR 7.6, 95% IC 2.8-20.6; p=<.001). In multivariate analysis TLS, need for dialysis and shock, kept statistical significance. Conclusions To our knowledge, this is the largest study that evaluates the impact over IM of biological, social, and economic factors in Hispanic adult patients with ALL. We identified factors not previously described such as hypertension and need for dialysis. Multicenter prospective studies most be urged to asses and validate these RF, and design a bedside prognostic score that can predict an increased risk of IM at ALL diagnosis. Disclosures No relevant conflicts of interest to declare.

Long-Term Results Of Allogeneic Stem Cell Transplantation In 56 Adult Patients With Philadelphia-Positive Acute Lymphoblastic Leukemia: A 20-Year Single Center Experience

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5521-5521
Author(s):  
Adalberto Ibatici ◽  
Fabio Guolo ◽  
Federica Galaverna ◽  
Clara Delle Piane ◽  
Alida Dominietto ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Retrospective Analysis ◽  
Induction Therapy ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
Long Term Results ◽  
Prognostic Impact ◽  
Single Center ◽  
Single Center Experience

Abstract Background Despite the great clinical benefit from the advent of tyrosine-kinase inhibitors (TKIs) treatment for adult patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), allogeneic hematopoietic stem cells transplantation (allo-HSCT) does not appear to be dispensable, if the optimal long-term outcome is to be achieved. However, there are only few data reported on long-term survivors with Ph+ ALL, particularly for those not receiving pre-transplant TKIs in the conventional induction therapy. In this retrospective analysis, we report on the long term outcomes of myeloablative allo-HSCT during the past 2 decades as single center experience. Data on the use of post-transplant TKIs and molecular monitoring for minimal residual disease are being collected to investigate their predictive role. Patients and methods Between 1989 and 2013, we collected 56 patients who underwent myeloablative allo-HSCT from HLA-identical siblings (n: 24), unrelated donors (n: 17), alternative donors (n: 15). Median age was 41 years (16-64). Disease phase at transplant was CR1 in 30 pts (53%), >CR1 in 26 pts. Pre-transplant TKI as part of induction therapy was given in 25 pts (44%). Conditioning regimen was TBI-based in 47 pts (83%) and chemotherapy-based in 9 pts. GVHD prophylaxis was given according to Center standard practice. Results Median follow-up was 67 months (1- 244). There were no cases of primary graft failure. Incidence of grade II-IV acute GVHD occurred in 31 pts (55%) and extensive chronic GVHD in 18 pts (32%). Transplant-related mortality was 35% at 2 years and 7 more patients died of non-relapse causes up to 12 years after transplant. The 10-year OS was 25% and significantly better for patients in CR1 vs. >CR1 (36% VS 14% - p=0,006). The 10-year DFS was 27% with no statistical difference for pts in CR1 vs. >CR1. Age at transplant and pre-transplant TKI did not affect the outcomes. Conclusions In this retrospective analysis over a 20-year time period, we show that approximately one-third of adult Ph+ ALL are cured if they undergo allo-HSCT in CR1. Therefore, we confirm that disease status at transplant has a major prognostic impact on clinical outcomes. The apparent lack of benefit of pre-transplant TKI exposure may be due to the retrospective nature of the analysis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals PF195 THE IMPACT OF COMORBIDITY ON SURVIVAL OF ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA

HemaSphere ◽  
2019 ◽  
Vol 3 (S1) ◽  
pp. 49-50
Author(s):  
R. Demichelis ◽  
P. Chouciño ◽  
A. García ◽  
R. Ramos ◽  
J.M. Sánchez ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
The Impact

Secondary Acute Lymphoblastic Leukemia after Primary Solid Organ Malignancy: A SEER Analysis of Incidence and Outcomes

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 935-935 ◽  
Author(s):  
Abhisek Swaika ◽  
Sikander Ailawadhi ◽  
Dongyun Yang ◽  
Laura E. Finn ◽  
Asher Chanan-Khan ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Adult Patients ◽  
Age At Diagnosis ◽  
Solid Organ ◽  
Relative Incidence ◽  
Race Ethnicity ◽  
Latency Interval ◽  
The Impact ◽  
Solid Organ Malignancy

Abstract Background: The incidence of secondary Acute Lymphoblastic leukemia (sALL) after a preceding first primary solid organ malignancy (1M) is not well defined. We undertook a Surveillance Epidemiology and End Results (SEER)-based analysis to describe the occurrence of sALL among adult patients with a history of common 1M's. We also evaluated differences in sALL survival on the basis of age, the site and extent of 1M, and for evidence of any underlying racial/ethnic disparity. Methods: The SEER-18 database (1973-2011) was interrogated for the current study. All confirmed cases of ALL (ICD-O-3 codes: 9811, 9812, 9814-18, 9826-28, 9835-37) in adult patients (age ≥18 years) were identified. De novo ALL vs. sALL was determined by using the SEER variable ‘First Malignant Primary Indicator'. 1M prior to the diagnosis of ALL was identified by merging all SEER databases together by patient ID number. Those with 1M stage of ‘in situ'; sALL cases reported <2 months after the diagnosis of 1M; and those with “unknown” information on 1M (n=471) were excluded. Standard race/ethnicity categories were used. Latency interval (time from diagnosis of 1M to sALL) was calculated for all patients. Overall survival (OS) was calculated as the interval from diagnosis to death, or censored at date of last contact, December 31st 2011, or 5 years after diagnosis, whichever came first. A proportional hazards Cox regression model was performed to evaluate the impact of sALL and latency on OS, adjusting for age at diagnosis, race/ethnicity, marital status, birthplace, SEER registry site, and year of diagnosis. All statistical tests were two-sided and utilized the SAS software (v9.4) with a two-sided significance level of 0.05. Results: A total of n=8,398 adult patients with primary ALL (1ALL) and n=414 with sALL were identified. Patient characteristics were significantly different between 1ALL & sALL (Table). Males comprised 49.8% of sALL patients as compared to 58% with 1ALL. Age at diagnosis of ALL was also significantly different, with 55.5% of sALL patients being ≥65 years as compared to 51.4% of 1ALL observed in the 18-44 years age group. Non-Whites comprised 27.3% of sALL and 40.4% of 1ALL, with Hispanics having the most differential distribution of 13.3% and 24.6%, respectively in the two groups. Distribution of sALL patients by latency from 1M is shown in Table. The majority of sALL patients had a diagnosis of local/regional (rather than advanced stage) 1M (Table). sALL patients had a significantly inferior OS when compared to 1ALL (HR 1.211, 95%CI 1.079-1.359) (Median OS 14 months vs. 18 months, Figure). sALL cases with longer latency interval (>5 year) appeared to have better median OS compared to shorter latency intervals, but this difference was not statistically significant (p=0.53). Conclusion: We have performed the largest population-based analysis identifying sALL after 1M, demonstrating that sALL patients are older and have significantly worse OS than 1ALL. We noted a lower relative incidence of sALL in Hispanics as compared with 1ALL, while the converse was true for Whites. Although detailed treatment data (specifically with respect to chemotherapeutic agents) is not available in SEER, it is possible that treatment for local/regional 1M - presumably adjuvant in nature - may be associated with the risk of sALL. Further analyses are required and are ongoing to confirm the relative incidence after specific 1M's, and the impact of both specific treatment modalities and the era of treatment for 1M on risk of developing sALL. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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