{Reference Type}: Journal Article
{Title}: Hyper-CVAD versus dose-adjusted EPOCH as initial treatment for adults with acute lymphoblastic leukemia.
{Author}: Zarling LC;Stevenson PA;Soma LA;Martino CH;Percival MM;Halpern AB;Ghiuzeli CM;Becker PS;Oehler VG;Cooper JP;Orozco JJ;Hendrie PC;Walter RB;Estey EH;Cassaday RD;
{Journal}: Eur J Haematol
{Volume}: 111
{Issue}: 6
{Year}: 2023 Dec 5
{Factor}: 3.674
{DOI}: 10.1111/ejh.14089
{Abstract}: <B>OBJECTIVE: </B>We 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.<BR><B>METHODS: </B>We 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).<BR><B>RESULTS: </B>Our 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.<BR><B>CONCLUSIONS: </B>Our 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.