(206) Remission Rates at End of Induction with HyperCVAD versus CALGB 19802 in Adult Acute Lymphoblastic Leukemia Patients

Poster Abstract: Background/Rationale:
Historically, acute lymphoblastic leukemia (ALL) was associated with high mortality and limited treatment options. However, intensive chemotherapy regimens have improved complete remission (CR) rates to 80-90% and long-term survival of 30-40% in all age groups. Many patients will have measurable residual disease (MRD) after completion of induction chemotherapy. Persistent MRD has been established as a poor prognostic factor and is associated with worse relapse-free survival, event-free survival, and overall survival (OS) compared to patients who achieve MRD negativity (MRD-). HyperCVAD and CALGB 19802 are two recommended frontline regimens for treating adult ALL. Both regimens are commonly used at Cleveland Clinic. CALGB 19802 utilizes the Berlin-Frankfurt-Munster backbone, which includes pegaspargase, while HyperCVAD omits pegaspargase. Pegaspargase, an important component of ALL treatment, is associated with a higher incidence and severity of toxicities in adults as compared to children. Major advances in the treatment of ALL have improved CR rates and OS, but it remains unclear which therapy, patient, or disease-state characteristics are associated with MRD- CR. The purpose of this study is to compare the end of induction efficacy and safety outcomes in adult ALL patients receiving frontline HyperCVAD or CALGB 19802. This study also aims to identify key characteristics that are associated with MRD- CR.
Primary

Objective: Compare end of induction MRD- CR rates in patients with newly diagnosed ALL who received HyperCVAD or CALGB 19802 induction chemotherapy
Secondary

Objectives:
1. Compare end of induction overall (MRD+ and MRD-) CR rates between patients who received HyperCVAD or CALGB 19802
2. Analyze safety outcomes between HyperCVAD and CALGB 19802 induction chemotherapy
3. Identify patient and disease state characteristics at diagnosis that may be associated with MRD-CR rates

Methods:
A retrospective, observational, cohort study of patients ≥ 40 years old diagnosed with ALL and treated with HyperCVAD or CALGB 19802 induction chemotherapy from January 1, 2014 to August 31, 2023 at Cleveland Clinic. Patients with chronic myeloid leukemia lymphoid blast crisis were also included. Baseline demographics and ALL characteristics were collected. Safety outcomes are characterized using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Univariate analysis will be utilized for baseline characteristics and multivariable analysis with logistic regression will be used to identify possible confounders. This study is IRB-approved.

Results: Results pending.
Conclusions/

Discussion: Results pending.

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