Hyper‐CVAD versus dose‐adjusted EPOCH as initial treatment for adults with acute lymphoblastic leukemia

Abstract

AbstractObjectivesWe recently performed a single‐arm phase II trial of DA‐EPOCH in adults with acute lymphoblastic leukemia (ALL). We sought to compare these results to those with standard Hyper‐CVAD.MethodsWe created a retrospective matched cohort of patients who received Hyper‐CVAD (n = 69) at our center and otherwise met eligibility criteria for the DA‐EPOCH trial (n = 53).ResultsOur outcomes support the use of Hyper‐CVAD over DA‐EPOCH in Ph− disease for both overall survival (OS; HR 0.18, p = .004) and event‐free survival (EFS; HR 0.51, p = .06). In contrast, outcomes were similar in Ph+ disease (OS HR 0.97, p = .96; EFS HR 0.65, p = .21). Rates of morphologic remission and measurable residual‐disease negativity were similar between the regimens. Hyper‐CVAD was associated with significantly more febrile neutropenia (OR 1.9, p = .03) and a greater incidence of Grade 4 or 5 adverse events (20% vs. 6%). Average transfusions per cycle of both red blood cells (p < .001) and platelets (p < .001) were five‐fold higher with Hyper‐CVAD.ConclusionsOur findings support continued use of Hyper‐CVAD for Ph− ALL but suggest that DA‐EPOCH may be a reasonable alternative for Ph+ ALL. These data also highlight a potential role for DA‐EPOCH in resource‐limited settings or when more intense therapy is not feasible.