Outcomes and adverse events in older acute lymphoblastic Leukemia patients treated with a pediatric-inspired protocol with Pegylated or native Asparaginase

ABSTRACT

This retrospective report presents the outcomes and adverse events (AEs) observed in 73 patients aged 60 years or older diagnosed with Philadelphia Chromosome-negative Acute Lymphoblastic Leukemia (Ph-negative ALL) treated with a pediatric-inspired protocol incorporating either Pegylated (PEG-ASP) or Native Asparaginase (EC-ASP). Notably, 61% of patients experienced AEs of Grade III-IV severity. The most prevalent AEs included thrombosis (35.6%), febrile neutropenia (38.4%), and transaminitis (34.2%). AEs did not translate into significant differences concerning overall survival, leukemia-free survival, or early mortality. Furthermore, we observed a reduction in early mortality rates (11% vs. 20%) and an increase in median overall survival (54 vs. 48 months) compared to our previous data. These findings suggest that the utilization of a pediatric-inspired chemotherapy protocol, with ASP, is an effective and well-tolerated therapeutic option for older patients with Ph-negative ALL. However, it emphasizes the importance of diligent monitoring and close follow-up throughout treatment.

KEYWORDS:

• Acute lymphoblastic leukemia; ALL
• elderly patients
• chemotherapy

Acknowledgement

We thank all the patients who underwent the journey of acute lymphoblastic leukemia treatment with us at the Princess Margaret Cancer Centre, University Health Network.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contribution of the authors

MAP, AC, and HS contributed to the study conceptualization and study design. MAP, EGA, and HS contributed to data analysis, interpretation, and writing of the manuscript. GV, MD, SA, YK, BA, DM, RCG, CS, SA, MM, and HS contributed to essential data, interpretations, and manuscript revision. All authors approved the submitted and final version.

Conflict of interest disclosure

This study has not been funded by any pharmaceutical companies. There were no direct COI specifically related to this research project.

ADS has received research funding from Takeda Pharmaceuticals, BMS, and Medivir AB, and consulting fees/honorarium from Takeda, Novartis, Jazz, and Otsuka Pharmaceuticals. ADS is named on a patent application for the use of DNT cells to treat AML. ADS is a member of the Medical and Scientific Advisory Board of the Leukemia and Lymphoma Society of Canada

All other authors report no conflicts of interest.