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Objectives: We recently performed a single‐arm phase II trial of DA‐EPOCH in adults with acute lymphoblastic leukemia (ALL). We sought to compare these results to those with standard Hyper‐CVAD. Methods: We created a retrospective matched cohort of patients who received Hyper‐CVAD (n = 69) at our center and otherwise met eligibility criteria for the DA‐EPOCH trial (n = 53). Results: Our outcomes support the use of Hyper‐CVAD over DA‐EPOCH in Ph− disease for both overall survival (OS; HR 0.18, p =.004) and event‐free survival (EFS; HR 0.51, p =.06). In contrast, outcomes were similar in Ph+ disease (OS HR 0.97, p =.96; EFS HR 0.65, p =.21). Rates of morphologic remission and measurable residual‐disease negativity were similar between the regimens. Hyper‐CVAD was associated with significantly more febrile neutropenia (OR 1.9, p =.03) and a greater incidence of Grade 4 or 5 adverse events (20% vs. 6%). Average transfusions per cycle of both red blood cells (p <.001) and platelets (p <.001) were five‐fold higher with Hyper‐CVAD. Conclusions: Our findings support continued use of Hyper‐CVAD for Ph− ALL but suggest that DA‐EPOCH may be a reasonable alternative for Ph+ ALL. These data also highlight a potential role for DA‐EPOCH in resource‐limited settings or when more intense therapy is not feasible. [ABSTRACT FROM AUTHOR]

Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense. To address this, we performed a phase II study of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). Imatinib or dasatinib was added for Ph + disease; rituximab was added when CD20+. Fifty-three patients were evaluable: 28 with Ph + disease, and 25 with Ph−. All patients had ≥1 high-risk clinical feature. Measurable residual disease-negativity by multiparameter flow cytometry within 4 cycles was achieved in 71% in patients with Ph + ALL and 64% in Ph − ALL. Median overall survival (OS) was 49 months, with a 2-year OS of 71%. Median relapse-free survival (RFS) in the 47 patients that attained morphologic remission was 24 months, with a 2-year RFS of 57%. Early mortality was 2%. In summary, DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death. [ABSTRACT FROM AUTHOR]