Leukemia research reports · 2025
Pediatric-inspired (R3) vs. Adult salvage (FA) chemotherapy in relapsed adolescents and young adults (AYA) acute lymphoblastic leukemia (ALL): A comparative outcome analysis.
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Lamine Chokri Ben, Alshehri Mohammed, Samhan Lara, Hassan Maha Abdullah, Elhassan Tusneem Ahmed M, Elfakih Riad, Alfraih Feras Abdulaziz, Ahmed Syed Osman, Hanbali Amr
Аннотация
BACKGROUND: Relapsed acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYA) remains a high-risk scenario with limited evidence guiding optimal salvage regimens. Pediatric-inspired protocols have improved frontline outcomes in AYA-ALL, yet their applicability in relapse remains undefined.
OBJECTIVE: To compare the clinical efficacy and toxicity of the pediatric-based UKALL R3 protocol versus the adult salvage fludarabine/cytarabine (FA) regimen in relapsed Philadelphia-negative AYA-ALL.
METHODS: A retrospective cohort study was conducted at a single tertiary care center including 77 patients aged 14-40 years with relapsed AYA-ALL. Seventeen patients received the R3 regimen and sixty received the FA protocol. Primary endpoints included complete remission (CR) rate and overall survival (OS). Secondary endpoints assessed minimal residual disease (MRD) response, transplantation rates, and treatment-related toxicities.
RESULTS: Baseline characteristics were comparable, though the FA cohort had older patients and higher-risk cytogenetics. CR rates were 60 % in R3 versus 76.3 % in FA (p=0.1). Median follow-up of 4 years showed numerically superior OS with R3 (53 % vs. 30.8 %, p=0.8). Toxicities varied: febrile neutropenia and hepatotoxicity were more frequent with FA, while mucositis and peripheral neuropathy predominated in R3. Infection-related deaths occurred less often in R3 (12.5 % vs. 25 %).
CONCLUSION: The pediatric-inspired R3 and adult-based FA regimens yielded similar survival and remission rates in relapsed AYA-ALL. Distinct toxicity profiles suggest that treatment selection should be individualized. Larger, prospective studies are warranted to validate the role of pediatric salvage protocols in this challenging population.
OBJECTIVE: To compare the clinical efficacy and toxicity of the pediatric-based UKALL R3 protocol versus the adult salvage fludarabine/cytarabine (FA) regimen in relapsed Philadelphia-negative AYA-ALL.
METHODS: A retrospective cohort study was conducted at a single tertiary care center including 77 patients aged 14-40 years with relapsed AYA-ALL. Seventeen patients received the R3 regimen and sixty received the FA protocol. Primary endpoints included complete remission (CR) rate and overall survival (OS). Secondary endpoints assessed minimal residual disease (MRD) response, transplantation rates, and treatment-related toxicities.
RESULTS: Baseline characteristics were comparable, though the FA cohort had older patients and higher-risk cytogenetics. CR rates were 60 % in R3 versus 76.3 % in FA (p=0.1). Median follow-up of 4 years showed numerically superior OS with R3 (53 % vs. 30.8 %, p=0.8). Toxicities varied: febrile neutropenia and hepatotoxicity were more frequent with FA, while mucositis and peripheral neuropathy predominated in R3. Infection-related deaths occurred less often in R3 (12.5 % vs. 25 %).
CONCLUSION: The pediatric-inspired R3 and adult-based FA regimens yielded similar survival and remission rates in relapsed AYA-ALL. Distinct toxicity profiles suggest that treatment selection should be individualized. Larger, prospective studies are warranted to validate the role of pediatric salvage protocols in this challenging population.