Phase II study of dose-adjusted EPOCH as initial therapy for adults with high-risk acute lymphoblastic leukemia.
Ryan D CassadayLucas C ZarlingKelsey-Leigh A GarciaOlga Sala-TorraPhilip A StevensonChristen H MartinoYajuan J LiuMin FangMary-Elizabeth M PercivalAnna B HalpernPamela S BeckerVivian G OehlerAndrei R ShustovJason P CooperJohnnie J OrozcoPaul C HendrieRoland Bruno WalterJerald P RadichLorinda A SomaElihu H EsteyPublished in: Leukemia & lymphoma (2023)
Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense. To address this, we performed a phase II study of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). Imatinib or dasatinib was added for Ph + disease; rituximab was added when CD20+. Fifty-three patients were evaluable: 28 with Ph + disease, and 25 with Ph-. All patients had ≥1 high-risk clinical feature. Measurable residual disease-negativity by multiparameter flow cytometry within 4 cycles was achieved in 71% in patients with Ph + ALL and 64% in Ph - ALL. Median overall survival (OS) was 49 months, with a 2-year OS of 71%. Median relapse-free survival (RFS) in the 47 patients that attained morphologic remission was 24 months, with a 2-year RFS of 57%. Early mortality was 2%. In summary, DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death.
Keyphrases
- newly diagnosed
- end stage renal disease
- acute lymphoblastic leukemia
- ejection fraction
- chronic kidney disease
- free survival
- flow cytometry
- clinical trial
- peritoneal dialysis
- squamous cell carcinoma
- low dose
- randomized controlled trial
- open label
- cardiovascular disease
- risk factors
- type diabetes
- drug delivery
- systemic lupus erythematosus
- deep learning
- allogeneic hematopoietic stem cell transplantation
- chronic myeloid leukemia
- acute myeloid leukemia