Outcome of T-Lymphoblastic Leukemia-Lymphoma with Hyper C-VAD Regimen
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Abstract
Background: T-cell lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) are aggressive diseases with dismal prognoses.
Materials and Methods: All adult patients with T-ALL and T-LBL who were candidates for the Hyper-CVAD chemotherapy protocol were included. We evaluated overall survival and progression-free survival in 46 new cases. The T-ALL and T-LBL’s number of cases were 32 and 14, respectively.
Results: Two- and 3-year OS were 41.8% (standard error (SE): 7%) and 27.8% (SE: 7%), respectively. Two- and 3-year PFS were 36.9% (SE: 7%) and 25.3% (SE: 7%), respectively. The only variable that had a significant relationship with the duration of PFS and OS was Allogenic SCT. Patients receiving Allogeneic SCT had longer survival time (2-year overall survival of 80% against 20%) (p˂0.001).
Conclusion: These data support the concept that Hyper-CVAD is not an appropriate and adequate regimen. We need new targeted agents in the T-ALL and T-LBL induction regimen while considering Allogeneic SCT as a Consolidation.
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7. Intermesoli T, Weber A, Leoncin M, et al. Lymphoblastic Lymphoma: A Concise Review. Curr Oncol Rep. 2022; 24(1):1-12.
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9. Huguet F, Leguay T, Raffoux E, et al. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009; 27(6):911–8.
10. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood.1995; 85(8):2025–37.
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. J Clin Oncol. 2000;18(3):547-61.
12. Kantarjian H, Thomas D, O'Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. 2004;101(12):2788-801.
13. Kota VK, Hathaway AR, Shah D, et al. Poor outcomes with hyper CVAD induction for T-Cell lymphoblastic leukemia/lymphoma. Blood. 2015; 126(23): 3762.
14. Kılıçaslan E, Sayın S, Yildirim M, et al. Higher Survival Advantage with Hyper-CVAD Chemotherapy Regimen Before Allogeneic Stem Cell Transplantation in Patients with High-Risk Adult Acute Lymphoblastic Leukemia: TwoCenter Experience. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 2022;9(3):215-220.
15. Gökbuget N, Kneba M, Raff T, et al. Adult patients with acute lymphoblastic leukemia and molecular failure display a poor prognosis and are candidates for stem cell transplantation and targeted therapies. Blood. 2012; 120(9):1868–76.
16. Thomas DA, O’Brien S, Cortes J, et al. Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma. Blood. 2004; 104(6):1624–30.
17. Erkut N, Akidan O, Batur DS, et al. Comparison between Hyper-CVAD and PETHEMA ALL-93 in Adult Acute Lymphoblastic Leukemia: A Single-Center Study. Chemotherapy. 2018;63(4):207-213.
18. Samra B, Alotaibi AS, Short NJ, et al. Outcome of adults with relapsed/refractory T-cell acute lymphoblastic leukemia or lymphoblastic lymphoma. Am J Hematol. 2020;95(9): E245–E247.
19. Pocock R, Farah N, Richardson SE, et al. Current and emerging therapeutic approaches for T-cell acute lymphoblastic leukaemia. Br J Haematol. 2021;194(1):28-43.
20. Xu J, Zhu HH. Targeted treatment of T-cell acute lymphoblastic leukemia: latest updates from the 2022 ASH Annual Meeting. Exp Hematol Oncol. 2023;12(1):30.
2. Marks DI, Paietta EM, Moorman AV, et al. T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993). Blood. 2009; 114(25):5136-45.
3. Ducassou S, Ferlay C, Bergeron C, et al. Clinical presentation, evolution, and prognosis of precur-sor B-cell lymphoblastic lymphoma in trials LMT96, EORTC 58881, and EORTC 58951: paediatric PBLL: evaluation of Current Oncology Reports (2022) 24:1–1281 3three trials. Br J Haematol. 2011; 152(4):441–51.
4. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016; 127(20):2391–405.
5. Litzow MR, Ferrando AA. How I treat T-cell acute lymphoblastic leukemia in adults. Blood. 2015; 126 (7): 833–841.
6. Kozlowski P , Åström M, Ahlberg L, et al. High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden. Eur J Haematol 2014;92(5):377-81
7. Intermesoli T, Weber A, Leoncin M, et al. Lymphoblastic Lymphoma: A Concise Review. Curr Oncol Rep. 2022; 24(1):1-12.
8. Stock W, La M, Sanford B, et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood. 2008; 112(5):1646–1654.
9. Huguet F, Leguay T, Raffoux E, et al. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009; 27(6):911–8.
10. Larson RA, Dodge RK, Burns CP, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood.1995; 85(8):2025–37.
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. J Clin Oncol. 2000;18(3):547-61.
12. Kantarjian H, Thomas D, O'Brien S, et al. Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia. Cancer. 2004;101(12):2788-801.
13. Kota VK, Hathaway AR, Shah D, et al. Poor outcomes with hyper CVAD induction for T-Cell lymphoblastic leukemia/lymphoma. Blood. 2015; 126(23): 3762.
14. Kılıçaslan E, Sayın S, Yildirim M, et al. Higher Survival Advantage with Hyper-CVAD Chemotherapy Regimen Before Allogeneic Stem Cell Transplantation in Patients with High-Risk Adult Acute Lymphoblastic Leukemia: TwoCenter Experience. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 2022;9(3):215-220.
15. Gökbuget N, Kneba M, Raff T, et al. Adult patients with acute lymphoblastic leukemia and molecular failure display a poor prognosis and are candidates for stem cell transplantation and targeted therapies. Blood. 2012; 120(9):1868–76.
16. Thomas DA, O’Brien S, Cortes J, et al. Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma. Blood. 2004; 104(6):1624–30.
17. Erkut N, Akidan O, Batur DS, et al. Comparison between Hyper-CVAD and PETHEMA ALL-93 in Adult Acute Lymphoblastic Leukemia: A Single-Center Study. Chemotherapy. 2018;63(4):207-213.
18. Samra B, Alotaibi AS, Short NJ, et al. Outcome of adults with relapsed/refractory T-cell acute lymphoblastic leukemia or lymphoblastic lymphoma. Am J Hematol. 2020;95(9): E245–E247.
19. Pocock R, Farah N, Richardson SE, et al. Current and emerging therapeutic approaches for T-cell acute lymphoblastic leukaemia. Br J Haematol. 2021;194(1):28-43.
20. Xu J, Zhu HH. Targeted treatment of T-cell acute lymphoblastic leukemia: latest updates from the 2022 ASH Annual Meeting. Exp Hematol Oncol. 2023;12(1):30.
| Files | ||
| Issue | Vol 19 No 4 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| T-ALL; T-LBL; Hyper-CVAD chemotherapy; Allogeneic SCT; Progression-Free Survival | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Namdari N, Ataei E, Ghanbarian F, Haghpanah S, Mokhtari M. Outcome of T-Lymphoblastic Leukemia-Lymphoma with Hyper C-VAD Regimen. Int J Hematol Oncol Stem Cell Res. 2025;19(4):332-337.
