The Efficacy of Pediatric-Inspired Regimens vs. Hyper-CVAD in the Treatment of Adolescents and Young Adults With Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis.

in American journal of hematology by Wenqing Su, Melisa Stricherz, Alison Martin, Jonathan Belsey, Eric Kemadjou, Daniel J DeAngelo

TLDR

  • This systematic review and meta-analysis found that ASP-containing pediatric-inspired regimens are associated with improved outcomes in adolescents and young adults with ALL/LBL compared to hyper-CVAD.
  • Patients receiving PIRs were more likely to achieve complete response and survive than those receiving hyper-CVAD.

Abstract

Adults with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) have poorer outcomes than pediatric patients. The aim of this systematic literature review and meta-analysis was to compare asparaginase (ASP)-containing pediatric-inspired regimens (PIRs) with hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) in adolescents and young adults (AYAs) with ALL/LBL. Searches included relevant publications up to April 21, 2022. A meta-analysis was conducted in four studies with comparable demographics, to estimate the effects of intervention on rates of response and survival. Patients receiving PIRs were approximately twice as likely to achieve complete response and 1.8 times more likely to survive than patients receiving hyper-CVAD. These results suggest ASP-containing PIRs are associated with improved outcomes in AYAs compared with hyper-CVAD.

Overview

  • This systematic literature review and meta-analysis aimed to compare asparaginase-containing pediatric-inspired regimens (PIRs) with hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) in adolescents and young adults (AYAs) with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL).
  • The study aimed to compare the efficacy of these two regimens in terms of response and survival rates in AYAs.
  • The study searched relevant publications up to April 21, 2022, and a meta-analysis was conducted in four studies with comparable demographics to estimate the effects of intervention on rates of response and survival.

Comparative Analysis & Findings

  • Patients receiving PIRs were approximately twice as likely to achieve complete response compared to patients receiving hyper-CVAD.
  • Patients receiving PIRs were 1.8 times more likely to survive than patients receiving hyper-CVAD.
  • The results suggest that ASP-containing PIRs are associated with improved outcomes in AYAs compared to hyper-CVAD.

Implications and Future Directions

  • These findings have significant implications for the treatment of ALL/LBL in AYAs, as they suggest that PIRs may be a more effective treatment option.
  • Future studies should aim to confirm these findings in larger cohorts and explore potential mechanisms by which PIRs may improve outcomes.
  • The study highlights the need for further research into the optimal treatment regimens for ALL/LBL in AYAs.
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