Induction Therapy in Adult Ph-negative ALL

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There is currently not a standard approach to induction treatment of adult patients with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL), explains Dan Douer, MD. Hematologists will often take a pediatric approach, at least with patients up to age 40 years and younger. These regimens include drugs that are less myelosuppressive, such as steroids and asparaginase, versus those in other pediatric treatments.

However, asparaginase is a more challenging drug to use with older patients. Therefore, for older adults with Ph- ALL, two fundamentally different approaches are used as induction therapy. One is hyper-CVAD (cyclophosphamide, vincristine sulfate, adriamycin, dexamethasone), a myelosuppressive combination without asparaginase. The other is the Berlin-Frankfurt-Münster (BFM) chemotherapy regimen.

Modifying the BFM regimen by integrating the least intensive vincristine and prednisone can be an option in very elderly patients, according to Mark R. Litzow, MD. In a fit elderly patient, a modified BFM regimen can also be used. Jeffrey Lancet, MD, reemphasizes that elderly patients can do well with more intensive chemotherapy regimens. As a result, there should be a generalized willingness to use more intensive regimens, especially in fit patients.