113 - SOHO 2014

Category: Acute Lymphoblastic Leukemia
Meeting: 2014 SOHO Annual Meeting
Citation: Society of Hematologic Oncology, SOHO Annual Meeting Proceedings. Vol 2, No. 1 (Sept 17), 2014:113.
Abstract #113
Delays in Intensification are Common in Adults with Acute Lymphoblastic Leukemia (ALL), are Associated with Decreased
Survival in Allogeneic Hematopoietic Cell Transplant (HCT) Patients
Anita Kumar, MD MS1, Phyllis Gimotty, PhD2, Joel Gelfand, MD MS3, Georgina Buck, MS4, Jacob Rowe, MD5, Anthony
Goldstone, MD6, Adele Fielding, MB BS PhD7, David Marks8, Mark Litzow, MD9, Elisabeth Paietta, PhD10, Hillard Lazarus, MD11,
Martin Tallman, MD12, Selina Luger, MD13, Alison Loren, MD MS14
1Hematology/Oncology, University of Pennsylvania; 2Perelman School of Medicine at the University of Pennsylvania,
University of Pennsylvania; 3Department of Dermatology, University of Pennsylvania; 4Clinical Trial Service Unit; 5Rambam
Medical Center; 6North London Cancer Network, University College London Hospital; 7Hematology, University College
London; 8University Hospitals NHS foundation trust; 9Mayo Clinic; 10Montefiore Medical Center; 11Case Western Reserve
University; 12Leukemia Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center; 13Department of
Hematology/Oncology, University of Pennsylvania; 14Department of Hematology/Oncology, University of Pennsylvania
Context: ALL has a high relapse rate in adults. While different biology may partly account for poorer survival in comparison
to children, adherence to complex chemotherapy regimens may also play a role.
Objective: To identify risk factors and outcomes associated with delays during chemotherapy for adults with ALL.
Design: We conducted an observational study using data from ECOG 2993/ MRC_UKALLXII. We analyzed Ph- patients who
started intensification after documented complete remission (CR). Long delay (LD) was defined as > 98 days from induction
start to intensification start (IS), corresponding with >2 weeks delay per protocol. Very Long Delay (VLD) was defined as a >4
weeks delay.
Results: 1247 patients met inclusion criteria. Female sex (p<0.001), Black race (p=0.01), and older age (p<0.001) were
associated with increased LD. During induction, infection (p=0.01), dose reductions (p=0.001), neutropenia duration
(p=0.007), thrombocytopenia (p<0.001), and hospitalization (p<0.001) were
Table 1.
associated with LD. Table I shows multivariate analysis risk factors. 687/1247 (55%)
patients died, with median time to death from IS of 13.3 months (0.8-231).
Myeloablative allogeneic HCT (allo HCT) patients had poorer overall survival from
start of intensification (OS-IS) and event free survival (EFS-IS) after VLD (p=0.02,
p=0.03). Survival was not worse for non-transplant patients after VLD (p=0.24,
p=0.10). In a multivariate Cox regression, allo HCT patients with a VLD had
significantly worse OS-IS (HR 1.4, p=0.02) and EFS-IS (HR 1.4, p=0.02). There was no
difference in OS or EFS in patients who received non-transplant post-remission
therapy based on delay.
Conclusion: In a comprehensive analysis of the largest adult ALL study reported,
we identified risk factors predictive of LD and VLD. Our findings highlighted that
delays were associated with chemotherapy toxicity and healthcare disparities.
Further studies will prospectively identify patient barriers to on-schedule treatment
with a goal of improved adherence and long-term survival.