Impact of triple intrathecal prophylaxis in acute lymphoblastic leukemia adults receiving HyperCVAD: A COVID‐19 practice change

Treatment of acute lymphoblastic leukemia (ALL) requires both systemically and locally directed therapies to prevent central nervous system (CNS) recurrence. In response to restrictions brought on by the COVID‐19 pandemic, our institution adopted triple intrathecal (IT) chemotherapy for CNS prophyla...

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Bibliographic Details
Published in:European journal of haematology 2023-07, Vol.111 (1), p.154-160
Main Authors: Lee, Benjamin J., Kongtim, Piyanuch, Doh, Jean, Griffin, Shawn P., Chan, Alexandre, O'Brien, Susan, Ciurea, Stefan O., Jeyakumar, Deepa
Format: Article
Language:English
Subjects:
Acute lymphoblastic leukemia
Central nervous system
Chemotherapy
chemotherapyCOVID‐19
CNS‐relapse
COVID-19
Cyclophosphamide
Cytarabine
Dexamethasone
Disease prevention
Doxorubicin
HyperCVAD
Leukemia
Lymphatic leukemia
Methotrexate
Patients
Prophylaxis
Survival
triple intrathecal
Vincristine
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Summary:Treatment of acute lymphoblastic leukemia (ALL) requires both systemically and locally directed therapies to prevent central nervous system (CNS) recurrence. In response to restrictions brought on by the COVID‐19 pandemic, our institution adopted triple intrathecal (IT) chemotherapy for CNS prophylaxis during HyperCVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with high‐dose methotrexate and cytarabine). We retrospectively reviewed records of newly diagnosed adult all patients who were consecutively treated with HyperCVAD between January 2011 and July 2022. Outcomes of patients who received triple IT chemotherapy and standard of care (SOC) CNS prophylaxis were compared. The primary endpoint was CNS relapse‐free survival (RFS) while secondary endpoints included cumulative incidence of relapse, overall survival, number of outpatient, and total ITs per patient, and CNS treatment‐related toxicities. A total of 37 patients including 21 in the triple IT and 16 in the SOC cohorts were evaluated. There were no differences between the triple IT and SOC cohorts with respect to CNS‐RFS (89.6% vs. 80.4%; HR, 1.55; 95% CI, 0.45–5.39; p = .49), cumulative incidence of relapse (8.9% vs. 19.6%; HR, 1.14; 95% CI, 0.3–5.3; p = .87), and overall survival (89.6% vs. 85.7%; HR, 0.91; 95% CI, 0.20–4.21; p = .90) at 2‐years. Significantly fewer IT doses were administered in the triple IT cohort (p = .011) and the number of additional outpatient appointments to administer IT chemotherapy were markedly reduced as 98.6% of IT doses were administered during scheduled admissions compared to 76.8% (p 
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.13980