Hyper‐CVAD plus nelarabine in newly diagnosed adult T‐cell acute lymphoblastic leukemia and T‐lymphoblastic lymphoma. Issue 1 (3rd November 2017)

• Record Type: Journal Article
• Authors: Abaza, Yasmin; M. Kantarjian, Hagop; Faderl, Stefan; Jabbour, Elias; Jain, Nitin; Thomas, Deborah; Kadia, Tapan; Borthakur, Gautam; D. Khoury, Joseph; Burger, Jan; Wierda, William; O'Brien, Susan; Konopleva, Marina; Ferrajoli, Alessandra; Kebriaei, Partow; Dabaja, Bouthaina; Kornblau, Steven; Alvarado, Yesid; Daver, Naval; Pemmaraju, Naveen; Bose, Prithviraj; Thompson, Philip; Al Azzawi, Hind; Kelly, Mary; Garris, Rebecca; Jain, Preetesh; Garcia‐Manero, Guillermo; Cortes, Jorge; Ravandi, Farhad
• Is Part Of: American journal of hematology. Volume 93:Issue 1(2018:Jan.)
• Page Start: 91
• Page End: 99
• Publication Date: 2017-11-03
• Subjects: Hematology -- Periodicals; 616.15
• DOI: 10.1002/ajh.24947
• Languages: English
• ISSNs: 0361-8609

Abstract

Abstract: Nelarabine, a water soluble prodrug of 9‐β‐D‐arabinofuranosylguanine (ara‐G), is a T‐cell specific purine nucleoside analogue. Given its activity in relapsed and refractory T acute lymphoblastic leukemia (T‐ALL) and T lymphoblastic lymphoma (T‐LBL), we sought to define its role in the frontline treatment of adult patients. Therefore, we conducted a single arm phase 2 study to determine the safety and efficacy of nelarabine in combination with hyper‐CVAD in newly diagnosed patients. For induction/consolidation, patients received eight cycles of hyper‐CVAD alternating with high‐dose methotrexate and cytarabine plus two cycles of nelarabine given at a dose of 650 mg/m 2 intravenously daily for 5 days. This was followed by thirty months of POMP maintenance chemotherapy with two additional cycles of nelarabine given instead of cycles 6 and 7 of POMP maintenance. Sixty‐seven patients, including 40 with T‐ALL and 26 with T‐LBL, were enrolled. Complete response rates in both T‐ALL and T‐LBL were 87% and 100% respectively. Grade 3 to 4 neurotoxic adverse events were reported in 5 patients. There were 21 relapses (31%) including 2 after allogeneic stem cell transplantation. Median duration of follow‐up was 42.5 months. The 3‐year complete remission duration (CRD) and overall survival (OS) rates were 66% and 65%, respectively. Compared to our historic hyper‐CVAD data, there was no survival benefit with the addition of nelarabine. In conclusion, hyper‐CVAD plus nelarabine was well tolerated and active in the frontline treatment of adult T‐ALL/LBL patients.