Contributions
Abstract: PB1375
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
Several factors influence the prognosis of adult patients with novo acute lymphoblastic leukemia (ALL)including the evaluation of the therapeutic response after induction MRD1(by Flow Cytometry or molecular methods). Unfortunately, access to molecular tests in our country is limited and measurement until a few years ago was based only on measurement of cytogenetic remission.
Aims
The purpose of our study was initially describe the characteristics of adult patients treated for de Novo ALL . The secondary aim was to assess the efficacy and tolerance of the treatments received in terms of OS and PFS as well as to define the prognostic factors influencing these parameters.
Methods
We retrospectively collected data from the medical records of all young patients(age>18 years) diagnosed as having de Novo ALL between January 2010 and September 2020 at the clinical hematology service of the military hospital of Instruction Mohammed V in Rabat.All the patients were treated according to several therapeutic protocols: GRAALL-2005 and GRAALL 2014 for young patients(<60 years old)and according to the GRAALL-SA or EWALL-PH-02 protocols for the elderly(>60 years old).The FRALLE 93 and FRALLE 2000 protocols have been used in patients aged between 18 and 20 years.Allo-HCT has been indicated in eligible patients classified as high risk with an HLA-matched donor
Results
Forty-five patients were enrolled in our study.Mean age at diagnosis was 34.37± 16.42 years with a sex ratio of 1.8.13.3% of patients had lymphadenopathy,15.6% hepato-splenomegaly and 33.3% of patients had a bone pain at diagnosis.More than half(66.7%)of all patients had an ALL with B-Phenotype(ALL-B II in 66.7%) and 33.3% LAL-T.33.3% of patients had leukocytosis(WBC>100,000/mm3 in ALL-T and >30,000/mm3 in ALL-B)and 6.7% had initial central nervous system involvement.Fourteen(31.1%) patients had an unfavorable karyotype of which nine were carriers a Philadelphia chromosome.The M-BCR-Abl and m-BCR-Abl transcripts were found in 7(15.5%) and 3(8.9%)patients respectively. Almost half(47.7%) of all patients were treated according to GRAALL-2005 protocol,13.3% based on GRAAL-2014 protocol.Only 8,9% were treated according to the GRAALL-SA and EWALLPH-02 protocols.Imatinib was the most widely used TKI(17.8%).Complete hematologic remission(CR1)after induction was obtained in 84.4% of cases.Thirteen(28.28%)patients underwent an Allo-HCT among then, two were ALL Ph positive.The donors were geno-identical in 22.2% of cases and haplo-identical,Matched unrelated Donod (MUD)or from umbilical Cord Blood(UCB)in 2.2% of cases.Haematological, infectious, thromboembolic/hemorrhagic toxicities were reported in 91.1%, 8.9% and 8.9%, respectively.Only one patient(2.2%)developed a L-Asparaginase-related toxicity and four(8.9%)patients had grade 1-3 peripheral neuropathy due to vincritine.In our series, multivariate analysis showed CR1 as being the only independent factor influencing both PFS[95% CI, 0,02-0.31](p = 0.00) and OS[95% CI, 0.06-0.58](p = 0.00).After a median follow-up of 27 months, the medians of PFS and OS were 19, 6 months and 37.3 months, respectively, with 24(53.3%) relapses and 18(40%) deaths.
Conclusion
The epidemiological and clinical profile of our patients is consistent with the findings of the studies. Our survival results are still lower than those reported in clinical trials. This may due to the limited access to Allo-HCT and the measurement of RC1 by molecular technics.It is a more precise reflection of therapeutic efficacy and allows the implementation of an optimized treatment, better adapted to the risks.
Keyword(s):
Abstract: PB1375
Type: Publication Only
Session title: Acute lymphoblastic leukemia - Clinical
Background
Several factors influence the prognosis of adult patients with novo acute lymphoblastic leukemia (ALL)including the evaluation of the therapeutic response after induction MRD1(by Flow Cytometry or molecular methods). Unfortunately, access to molecular tests in our country is limited and measurement until a few years ago was based only on measurement of cytogenetic remission.
Aims
The purpose of our study was initially describe the characteristics of adult patients treated for de Novo ALL . The secondary aim was to assess the efficacy and tolerance of the treatments received in terms of OS and PFS as well as to define the prognostic factors influencing these parameters.
Methods
We retrospectively collected data from the medical records of all young patients(age>18 years) diagnosed as having de Novo ALL between January 2010 and September 2020 at the clinical hematology service of the military hospital of Instruction Mohammed V in Rabat.All the patients were treated according to several therapeutic protocols: GRAALL-2005 and GRAALL 2014 for young patients(<60 years old)and according to the GRAALL-SA or EWALL-PH-02 protocols for the elderly(>60 years old).The FRALLE 93 and FRALLE 2000 protocols have been used in patients aged between 18 and 20 years.Allo-HCT has been indicated in eligible patients classified as high risk with an HLA-matched donor
Results
Forty-five patients were enrolled in our study.Mean age at diagnosis was 34.37± 16.42 years with a sex ratio of 1.8.13.3% of patients had lymphadenopathy,15.6% hepato-splenomegaly and 33.3% of patients had a bone pain at diagnosis.More than half(66.7%)of all patients had an ALL with B-Phenotype(ALL-B II in 66.7%) and 33.3% LAL-T.33.3% of patients had leukocytosis(WBC>100,000/mm3 in ALL-T and >30,000/mm3 in ALL-B)and 6.7% had initial central nervous system involvement.Fourteen(31.1%) patients had an unfavorable karyotype of which nine were carriers a Philadelphia chromosome.The M-BCR-Abl and m-BCR-Abl transcripts were found in 7(15.5%) and 3(8.9%)patients respectively. Almost half(47.7%) of all patients were treated according to GRAALL-2005 protocol,13.3% based on GRAAL-2014 protocol.Only 8,9% were treated according to the GRAALL-SA and EWALLPH-02 protocols.Imatinib was the most widely used TKI(17.8%).Complete hematologic remission(CR1)after induction was obtained in 84.4% of cases.Thirteen(28.28%)patients underwent an Allo-HCT among then, two were ALL Ph positive.The donors were geno-identical in 22.2% of cases and haplo-identical,Matched unrelated Donod (MUD)or from umbilical Cord Blood(UCB)in 2.2% of cases.Haematological, infectious, thromboembolic/hemorrhagic toxicities were reported in 91.1%, 8.9% and 8.9%, respectively.Only one patient(2.2%)developed a L-Asparaginase-related toxicity and four(8.9%)patients had grade 1-3 peripheral neuropathy due to vincritine.In our series, multivariate analysis showed CR1 as being the only independent factor influencing both PFS[95% CI, 0,02-0.31](p = 0.00) and OS[95% CI, 0.06-0.58](p = 0.00).After a median follow-up of 27 months, the medians of PFS and OS were 19, 6 months and 37.3 months, respectively, with 24(53.3%) relapses and 18(40%) deaths.
Conclusion
The epidemiological and clinical profile of our patients is consistent with the findings of the studies. Our survival results are still lower than those reported in clinical trials. This may due to the limited access to Allo-HCT and the measurement of RC1 by molecular technics.It is a more precise reflection of therapeutic efficacy and allows the implementation of an optimized treatment, better adapted to the risks.
Keyword(s):