Universidad Autónoma de Nuevo Léon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Hematology Service, Monterrey, Mexico.
Universidad Autónoma de Nuevo Léon, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Hematology Service, Monterrey, Mexico.
Clin Lymphoma Myeloma Leuk. 2022 Dec;22(12):883-893. doi: 10.1016/j.clml.2022.07.014. Epub 2022 Aug 1.
B-cell acute lymphoblastic leukemia is frequent in Hispanic adolescents and young adults. Outcomes of implementation of pediatric-inspired regimens in low-and middle-income countries are not well known.
In this study we treated 94 adolescents and young adults with a local BFM regimen designed to be affordable with the use of native L-asparaginase and mitoxantrone administered in an outpatient fashion, and the of BCR/ABL and measurable residual disease (MRD) determined by high sensitivity flow cytometry for risk stratification.
Induction mortality was 11%; 25% of patients had to abandon treatment or be transferred to another health system. Two-year overall (OS) and event free survival (EFS) were 61.5% and 49.8%, MRD-negative patients had a 24-month OS of 85.6% vs. 69.6% (p = .024) and EFS of 76% vs. 45.5% (p = .004). Patients older than 40 years and those who abandoned treatment had worse EFS. Overall drug costs in our regimen were 52% lower than those of CALGB10403.
The treatment of AYAs with ALL with an outpatient focus was implemented successfully at a reduced cost. Genetic risk assessment, treatment abandonment and lack of access to novel therapies remain major barriers for improving outcomes.
B 细胞急性淋巴细胞白血病在西班牙裔青少年和年轻成年人中较为常见。在中低收入国家实施儿科启发的方案的结果尚不清楚。
在这项研究中，我们用一种当地的 BFM 方案治疗了 94 名青少年和年轻成年人，该方案旨在使用本地 L-天冬酰胺酶和米托蒽醌以门诊方式给药来负担得起，并用高灵敏度流式细胞术检测 BCR/ABL 和可测量的残留疾病（MRD）进行风险分层。
诱导死亡率为 11%；25%的患者不得不放弃治疗或转移到另一个医疗系统。两年的总生存率（OS）和无事件生存率（EFS）分别为 61.5%和 49.8%，MRD 阴性患者 24 个月的 OS 为 85.6%，EFS 为 76%（p =.024）。年龄大于 40 岁和放弃治疗的患者 EFS 较差。我们方案中的总体药物成本比 CALGB10403 低 52%。
以门诊为重点的 ALL 治疗 AYA 成功实施，成本降低。遗传风险评估、治疗放弃和缺乏新疗法仍然是改善结果的主要障碍。
