Main Article Content

Shivani Shokhanda
Vipin Kumar
Dr Ashwani Kumar
Om Joshi
Neetu jangra


COG regimen, adolescent and young adults, acute lymphoblastic leukemia, event-free survival, overall survival


Purpose: Considering the young age and good tolerability to chemotherapies, adolescents and young adults (AYA) patients with acute lymphoblastic leukemia (ALL) are nowadays treated with more intensive pediatric protocols and consequently demonstrated improved outcomes in several studies. The purpose of this study was to evaluate the efficacy of  COG0232 regimen on AYA ALL patients.

Methods: Medical records of newly diagnosed ALL patients registered between 2012- 2016 were screened. We analyzed data of 115 patients retrospectively for their post- induction remission, mortality and survival rates.

Results: Out of 115 patients, complete remission (CR) was achieved in 90 patients post induction chemotherapy. Additionally, after receiving salvage induction 02 patients achieved CR. Therefore, we observed an overall CR rate of 80%. MRD was found positive in 34.2% and negative in 65.8% patients at the end of induction. Majority of the 16 MRD positives (77%) were observed in B-ALL group. The event-free survival (EFS) and overall survival (OS) reported were 51.3% and 54% respectively, with more than 4 years of follow-up. EFS and OS were found significantly associated with post-induction remission (p-value = <0.0001, <0.0001 respectively) and post-induction MRD (p-value = <0.0075, <0.0275 respectively).

Conclusion: In conclusion, using a pediatric regimen for AYAs with ALL up to the age of 40 years is a feasible and beneficial treatment option, resulting in better survival rates.

Abstract 57 | pdf Downloads 20


1. Terwilliger T, Abdul-Hay M (2017) Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood Cancer J 7:e577. https://doi.org/10.1038/bcj.2017.53
2. Davis JC, Wistinghausen B (2019) Acute lymphoblastic leukemia. Oncology 319–331. https://doi.org/10.1002/9781119189596.ch28
3. Chang JE, Medlin SC, Kahl BS, et al (2008) Augmented and standard BFM chemotherapy for treatment of adult ALL. 49:2298–2307. https://doi.org/10.1080/10428190802517732. Augmented
4. Rajendra A, Jain H, Bonda VNA, et al (2021) Outcomes and prognostic factors in adolescents and
5. young adults with ALL treated with a modified BFM-90 protocol. Blood Adv 5:1178–1193.
6. https://doi.org/10.1182/bloodadvances.2020003526
7. Trehan A, Bansal D, Varma N, Vora A (2017) Improving outcome of acute lymphoblastic leukemia with a simplified protocol: report from a tertiary care center in north India. Pediatr Blood Cancer 64:1–8. https://doi.org/10.1002/pbc.26281
8. Ganesan P, Sagar TG, Kannan K, et al (2018) Acute Lymphoblastic Leukemia in Young Adults Treated with Intensive “Pediatric” Type Protocol. Indian J Hematol Blood Transfus 34:422–429. https://doi.org/10.1007/s12288-017-0892-y
9. Jain P, Korula A, Deshpande P, et al (2018) Adult acute lymphoblastic leukemia: Limitations of intensification of therapy in a developing country. J Glob Oncol 2018:.
10. Muffly L, Petit K, Stock W (2012) Treating the younger adult with acute lymphoblastic leukemia. Clin Pract 9:439–449. https://doi.org/10.2217/cpr.12.30
11. Ribera JM, Oriol A, Sanz MA, et al (2008) Comparison of the results of the treatment of adolescents and young adults with standard-risk acute lymphoblastic leukemia with the programa Español detratamiento en hematología pediatric-based protocol ALL-96. J Clin Oncol 26:1843–1849. https://doi.org/10.1200/JCO.2007.13.7265
12. DeAngelo DJ, Stevenson KE, Dahlberg SE, et al (2015) Long-term outcome of a pediatric-inspired regimen used for adults aged 18-50 years with newly diagnosed acute lymphoblastic leukemia. Leukemia 29:526–534. https://doi.org/10.1038/leu.2014.229
13. Wieduwilt MJ, Stock W, Advani A, et al (2021) Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALG. Leukemia 35:2076–2085. https://doi.org/10.1038/s41375-021- 01213-5
14. Larson RA, Dodge RK, Burns CP, et al (1995) A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: Cancer and leukemia group B study 8811. Blood 85:2025–2037. https://doi.org/10.1182/blood.v85.8.2025.blood journal8582025
15. Stock W, Johnson JL, Stone RM, et al (2013) Dose intensification of daunorubicin and cytarabine during treatment of adult acute lymphoblastic leukemia: Results of Cancer and Leukemia Group B Study 19802. Cancer 119:90–98. https://doi.org/10.1002/cncr.27617
16. Pulte D, Gondos A, Brenner H (2008) Trends in 5- and 10-year survival after diagnosis with childhood hematologic malignancies in the United States, 1990-2004. J Natl Cancer Inst 100:1301–1309. https://doi.org/10.1093/jnci/djn276
17. Riehm H, Gadner H, Welte K (1977) [The west-berlin therapy study of acute lymphoblastic leukemia in childhood--report after 6 years (author’s transl)]. Klin Padiatr 189:89–102
18. Ganesan P, Jain H, Bagal B, et al (2021) Outcomes in adolescent and young adult acute lymphoblastic leukaemia: a report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 193:e1–e4. https://doi.org/10.1111/bjh.17268
19. Boissel N, Baruchel A (2018) Acute lymphoblastic leukemia in adolescent and young adults: Treat as adults or as children? Blood 132:351–361. https://doi.org/10.1182/blood-2018-02-778530
20. Borowitz MJ, Wood BL, Devidas M, et al (2015) Prognostic significance of minimal residual disease in high risk B-ALL: A report from Children’s Oncology Group study AALL0232. Blood 126:964–971. https://doi.org/10.1182/blood-2015-03-633685
21. Pui CH, Pei D, Campana D, et al (2011) Improved prognosis for older adolescents with acute lymphoblastic leukemia. J Clin Oncol 29:386–391. https://doi.org/10.1200/JCO.2010.32.0325
22. Ram R, Wolach O, Vidal L, et al (2012) Adolescents and young adults with acute lymphoblastic leukemia have a better outcome when treated with pediatric-inspired regimens: Systematic review and meta-analysis. Am J Hematol 87:472–478.
23. Malhotra P, Varma S, Varma N, et al (2007) Outcome of adult acute lymphoblastic leukemia with BFM protocol in a resource-constrained setting. Leuk Lymphoma 48:1173–1178. https://doi.org/10.1080/10428190701343255
24. Boissel N, Auclerc MF, Lhéritier V, et al (2003) Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol 21:774–780. https://doi.org/10.1200/JCO.2003.02.053