Original Article

Evaluation of Central Nervous System Relapse in Adults with Acute Lymphoblastic Leukemia (ALL) Receiving Hyper-CVAD Treatment in Seyyed Al-Shohada Hospital: Isfahan, 2014-2019

Abstract

Background: Recurrence of ALL in the central nervous system, CNS Relapse, is known as a poor prognostic factor. Few studies have been performed on the CNS Relapse in adults with ALL. This study aimed to evaluate the recurrence of acute lymphoblastic leukemia in the central nervous system, CNS relapse, in adults with ALL.

Materials and Methods: Seventy newly diagnosed patients with acute lymphoblastic leukemia aged 15 years and older referred to Seyyed Al-Shohada Hospital in Isfahan between 2014 and 2019 were included in this study. All patients treated with the Hyper-CVAD regimen underwent prophylaxis for the central nervous system based on the risk of CNS relapse. All study participants with CNS relapse underwent intrathecal chemotherapy.

Results: The median age of patients was 34 years. Four patients (5.7%) had primary central nervous system involvement. Out of 70 patients receiving the Hyper-CVAD regimen, 59 (84.2%) achieved complete remission. Of the 59 patients achieving CR, ten (16.94%) developed CNS relapse.

The median duration of CR before CNS relapse was 21 weeks. Out of 10 patients with CNS relapse, seven (70%) achieved complete remission. Of seven patients achieving CR in the central nervous system, one had a second recurrence in the central nervous system, but finally achieved CNS complete remission. The median survival of patients after CNS relapse was four months. The results also showed that out of 10 patients with CNS relapse, four (40%) survived one year.

Conclusion: This study shows that the prognosis of CNS relapse in adults with ALL has not improved much. Limited studies have been conducted on the recurrence of the central nervous system in adults with acute lymphoblastic leukemia. Therefore, further studies on CNS relapse after complete remission of ALL are required to clarify more details.

1.Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J. 2017;7(6):e577-e.
2.Abbasi S, Maleha F, Shobaki M. Acute Lymphoblastic Leukemia Experience: Epidemiology and Outcome of Two Different Regimens. Mediterr J Hematol Infect Dis. 2013;5(1):e2013024.
3.Thomas X, Le QH. Central nervous system involvement in adult acute lymphoblastic leukemia. Hematology. 2008;13(5):293-302.
4.Jabbour E, O'Brien S, Konopleva M, et al. New insights into the pathophysiology and therapy of adult acute lymphoblastic leukemia. Cancer. 2015;121(15):2517-28.
5.Del Principe MI ML, Buccisano F, Sconocchia G, et al. Central nervous system involvement in adult acute lymphoblastic leukemia: Diagnostic tools, prophylaxis, and therapy. Mediterr J Hematol Infect Dis.. 2014;6(1):e2014075.
6.Surapaneni U, Cortes J, Thomas D, et al. Central Nervous system relapse in adults with acute lymphoblastic leukemia. Cancer. 2002;94(3):773-9.
7.Sharifian Ra, Hajigholami A, Safaei S. Short-term outcome of hyper-cvad treatment in acute lymphocytic leukemia in Iran. Int J Hematol-Oncol Stem Cell Res. 2009;3(4SUPPL 1):4-4.
8.Mehrzad V, Ahmadifar A, Mahmoudzadeh M. Evaluate the Response Rate of Acute Lymphocytic Leukemia Patients to Hyper Cyclophosphamide, Vincristine, Adriamycin, and Dexamethasone Regimen and Remission Rate to Stay Until the End of the Arbitrary Treatment. Adv Biomed Res. 2018;7:81.
9. Haghighi S, Rezvani H, Attarian H, et al . Surveying the efficacy of HyperCVAD regimen in acute lymphoblastic leukemia patients. Pajoohande. 2009; 14 (4):225-231.
10. Azadbakht S, Moeinzadeh F, Mehrzad V, et al. Evaluating the Feasibility of Prescribing Hyper-CVAD Regimen in Adult Acute Lymphoblastic Leukemia. J Isfahan Med Sch. 2012; 30 (193): 842-849.
11.Kantarjian HM, O’Brien S, Smith TL, et al. Results of Treatment With Hyper-CVAD, a Dose-Intensive Regimen, in Adult Acute Lymphocytic Leukemia. JClin Oncol. 2000;18(3):547-61.
12.Larson RA. Managing CNS disease in adults with acute lymphoblastic leukemia. LeukLymphoma. 2018;59(1):3-13.
13.Sancho JM, Ribera J, Oriol A, et al. Central nervous system recurrence in adult patients with acute lymphoblastic leukemia: Frequency and prognosis in 467 patients without cranial irradiation for prophylaxis. Cancer. 2006;106(12):2540-6.
Files
IssueVol 18, No 1 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v18i1.14743
Keywords
CNS relapse; Acute lymphoblastic leukemia; Hyper CVAD treatment; One-year survival
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sadeghi A, Gardashti R, Ashrafi F, Mehrzad V. Evaluation of Central Nervous System Relapse in Adults with Acute Lymphoblastic Leukemia (ALL) Receiving Hyper-CVAD Treatment in Seyyed Al-Shohada Hospital: Isfahan, 2014-2019. Int J Hematol Oncol Stem Cell Res. 2024;18(1):47-52.