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. 2021 Mar 9;5(5):1178-1193.
doi: 10.1182/bloodadvances.2020003526.

Outcomes and prognostic factors in adolescents and young adults with ALL treated with a modified BFM-90 protocol

Akhil Rajendra  1 , Hasmukh Jain  2 , V N Avinash Bonda  2 , Lingaraj Nayak  2 , Prashant Tembhare  3 , Dhanlaxmi Shetty  4 , Jayashree Thorat  2 , Hemani Jain  4 , Papagudi Ganesan Subramanian  3 , Nikhil Patkar  3 , Gaurav Chatterjee  3 , Navin Khattry  2   5 , Anant Gokarn  2   5 , Sachin Punatar  2   5 , Smruti Mokal  6 , Bhausaheb Bagal  2 , Manju Sengar  2
Affiliations

Outcomes and prognostic factors in adolescents and young adults with ALL treated with a modified BFM-90 protocol

Akhil Rajendra et al. Blood Adv. .

Abstract

The use of pediatrics-inspired protocols in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL) results in superior survival compared with the adult protocols. Pediatrics-inspired protocols carry an increased risk of toxicity and treatment-related mortality in low resource settings, which can offset the potential benefits. We studied the outcomes and prognostic factors in the treatment of AYA ALL with a pediatrics-inspired regimen. We retrieved data regarding demographics, investigations, treatment details, and toxicities from the electronic medical records of patients diagnosed with ALL in the 15- to 25-year-old age group who were initiated on a modified Berlin-Frankfurt-Münster 90 (BFM-90) protocol between January 2013 and December 2016 at the Tata Memorial Centre. A total of 349 patients in the 15- to 25-year-old age group were treated with a modified BFM-90 protocol. The use of this pediatrics-inspired protocol resulted in a 3-year event-free survival (EFS) and overall survival (OS) of 59.4% and 61.8%, respectively. Only 15 patients underwent an allogeneic stem cell transplant. Minimal residual disease (MRD) persistence postinduction emerged as the only factor predictive of poor outcomes. A modified BFM-90 protocol is an effective and safe regimen for AYA ALL with an OS and EFS comparable to the published literature.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Graphical representation of the treatment and follow-up of the 349 patients. *High dose AraC (Leg2 I2A of MCP841 protocol)  started in view of ongoing infection (empyema). Allo HSCT, allogeneic HSCT; Ara C, cytarabine; BMT, bone marrow transplantation; CML, chronic myeloid leukemia; CVT, cerebral venous thrombosis; HDAraC, high-dose cytarabine; LFU, lost to follow-up.
Figure 2.
Figure 2.
EFS and OS survival curves for the overall population and subgroups. (A) Overall population. (B) B-ALL subgroup (including BCR-ABL positive). (C) BCR-ABL positive subgroup. (D) T-ALL subgroup. (E) T-LBL subgroup. (F-G): OS and EFS for ETP/near ETP vs non-ETP ALL.
Figure 3.
Figure 3.
EFS and OS according to the postinduction MRD and risk stratification. OS (A) and EFS (B), postinduction MRD negative vs positive. OS (C) and EFS (D), MRD negative postinduction vs MRD negative during or after consolidation. OS (E) and EFS (F) for high-risk vs low-risk patients.
See this image and copyright information in PMC

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