A Bortezomib-Based Protocol Induces a High Rate of Complete Remission with Minor Toxicity in Adult Patients with Relapsed/Refractory Acute Lymphoblastic Leukemia
| Autor: | Boaz Nachmias, Alexander Gural, Michael Y. Shapira, Adir Shaulov, Moshe E. Gatt |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Oncology medicine.medical_specialty Vincristine Asparaginase Adolescent medicine.medical_treatment Population Donor lymphocyte infusion Bortezomib 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Recurrence Internal medicine Antibodies Bispecific Antineoplastic Combined Chemotherapy Protocols medicine Humans education Dexamethasone Aged Bone Marrow Transplantation Febrile Neutropenia Retrospective Studies education.field_of_study Chemotherapy business.industry Remission Induction Hematology General Medicine Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma chemistry 030220 oncology & carcinogenesis Blinatumomab business 030215 immunology medicine.drug |
| Zdroj: | Acta Haematologica. 140:209-214 |
| ISSN: | 1421-9662 0001-5792 |
| DOI: | 10.1159/000493252 |
| Popis: | The treatment of relapsed/refractory acute lymphoblastic leukemia (RR-ALL) presents a true clinical challenge. In 2012, a protocol combining bortezomib, dexamethasone, asparaginase, doxorubicin, and vincristine administered to children with RR-ALL was published with encouraging results. Over the past 5 years, we have implemented this protocol in the adult RR-ALL population (> 18 years) and addressed its feasibility in terms of remission rate and toxicity. Here, we present the results of our experience in 9 patients, all of whom received multiple previous chemotherapy protocols, two of them relapsing after an allogeneic bone marrow transplantation. All of the five B-ALL patients, and two of the four T-ALL achieved complete remission. Of the seven patients achieving complete remission, two patients were referred for allogeneic bone marrow transplantation, two patients were subsequently given blinatumomab, and one patient subsequently received donor lymphocyte infusion followed by blinatumomab. Thus, five out of nine patients treated (55%) were able to proceed to best available therapy in a complete remission. We observed minimal adverse effects, mainly hematological toxicity. We conclude that the bortezomib-based protocol should be evaluated as an effective and well-tolerated treatment option for adult patients either unfit for or failing standard salvage chemotherapy, as a bridge to immunotherapy or allogeneic bone marrow transplantation. |
| Databáze: | OpenAIRE |
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