By: Kerri Fitzgerald
Researchers introduced a pediatric-inspired treatment protocol at their institution for patients with Philadelphia-negative (Ph–) acute lymphoblastic leukemia (ALL) and found that overall survival (OS) and mortality outcomes did not significantly differ pre- and post-implementation.
Maria Agustina Perusini, MD, of Princess Margaret Cancer Centre in Toronto, presented the findings at the 2025 EHA Congress.
The researchers instituted a pediatric-inspired protocol for Ph– ALL patients aged up to 60 years that focuses on minimizing adverse events and improving outcomes, with a key change being asparaginase formulation adjustments based on asparaginase activity level.
The retrospective study included 266 newly-diagnosed patients (median age, 37 years; 42.86% were female). Researchers compared outcomes from two time periods: 2001 to 2012 (n=132) versus 2013 to 2023 (n=136). Asparaginase was considered complete when patients received 80% of the expected dose.
Asparaginase completion rate was 75.22% in the first time period and 60.69% in the second time period (P=0.014).
Complete remission rates were similar at 95.27% and 92.55%, respectively (P=0.307), though median follow-up was significantly longer in the first time period: 75.5 months versus 49.0 months (P<0.01).
Two-year cumulative incidence of relapse was 20.43% overall, and did not significantly differ between the time periods studied: 20.00% versus 20.83% (P=0.245). Two-year OS was 80.38% overall, 80.40% in time period one, and 80.36% in time period two. Four-year OS also did not differ: 74.02%, 77.66%, and 70.41%, respectively (P=0.3175).
“The decrease in asparaginase completion rates in [time period two] may be related to changes in formulation, potentially contributing to the lack of improvement in outcomes,” the authors noted.
Patients who completed the expected asparaginase dose had significantly longer one-year OS: 95.92% versus 69.10% (P=0.014).
“We are now eager to incorporate novel therapies into the frontline setting, combined with better-tolerated asparaginase formulations and better tools for prognosis stratification and measurable residual disease to improve patient outcomes,” the researchers concluded.
Reference
Perusini MA, Wei J, Gupta V, et al. Real-world outcomes of Philadelphia chromosome-negative acute lymphoblastic leukemia in adults treated with a pediatric-inspired protocol: a comparison across two time periods. Abstract #PS1392. Presented at the European Hematology Association 2025 Congress; June 12-15, 2025; Milan, Italy.
