Haematologica Spotlight：A Chinese team published the largest-scale pediatric-style regimen treatment for adult Ph-negative ALL
🔬 *Haematologica Spotlight* 🔬
A Chinese team published the largest-scale pediatric-style regimen treatment for adult Ph-negative ALL
Acute Lymphoblastic Leukemia (ALL)
is a hematological malignancy characterized by the proliferation of immature lymphoid cells in the bone marrow, peripheral blood, and extramedullary sites. While the prognosis for childhood ALL is relatively favorable, with a 5-year overall survival rate of 80-90%, adult ALL poses greater challenges. Approximately 20-30% of adult acute leukemias are ALL, with about two-thirds being Philadelphia chromosome-negative (Ph-negative) ALL. Conventional adult ALL treatments have shown high remission rates but also high relapse rates and poor long-term survival.
Haematologica
Inspired by the success of pediatric ALL treatments, especially in adolescent and young adult patients, the Hematology Center at the
Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
embarked on a groundbreaking journey. Their pioneering research, recently published in *Haematologica*, presents the results of the largest prospective cohort study in China investigating the efficacy of a pediatric-inspired regimen in adult Ph-negative ALL patients.
The study, led by Dr. Wang Jianxiang and his team,
evaluated the IH-2014 regimen’s effectiveness in 415 newly diagnosed adult Ph-negative ALL patients treated between April 2014 and December 2021, with a median age of 27 years (range 14-65 years) and a median follow-up of 40.8 months. The overall 5-year overall survival (OS) and disease-free survival (DFS) rates were 53.8% and 51.1%, respectively, with a chemotherapy-related mortality rate of 3.6%.
Patients achieving complete remission (CR)
after induction therapy with available bone marrow minimal residual disease (MRD) data were categorized based on diagnostic risk: standard-risk (SR) MRD-negative (<0.01%) in 73 patients (18.8%), SR MRD-positive (≥0.01%) in 69 patients (17.7%), high-risk (HR) MRD-negative in 120 patients (30.8%), and HR MRD-positive in 127 patients (32.6%). The 5-year OS rates for these groups were 82.6%, 58.7%, 58.3%, and 36.1%, respectively (P＜0.001), with corresponding cumulative relapse rates of 24.2%, 41.1%, 36.3%, and 50.1% (P＜0.001). Multivariate analysis identified age ≥40 years and MRD positivity after induction as independent adverse prognostic factors for OS and DFS.
In conclusion, the IH-2014 regimen demonstrates significant efficacy and good tolerability in adult Ph-negative ALL patients, with younger patients (<40 years) benefiting more prominently. Induction treatment response combined with MRD levels serves as a valuable prognostic indicator for long-term survival and relapse, guiding allogeneic hematopoietic stem cell transplantation decisions in patients achieving first complete remission (CR1).
This study marks a pivotal milestone in advancing adult ALL treatment strategies, showcasing China’s remarkable progress in the field of hematology. Stay tuned for more groundbreaking research from our team!
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Email: doctor.huang@globecancer.com,
WhatsApp: +8613717959070
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