Cargando…

Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians

BACKGROUND: The prognosis for adult patients with Ph(-) B-precursor acute lymphoblastic leukaemia (ALL) who are refractory to treatment or experience relapse (R/R), is poor; over 90 % of these patients die from the disease, typically within a few months. While there are some national guidelines publ...

Descripción completa

Detalles Bibliográficos
Autores principales: Saltman, Deborah, Barlev, Arie, Seshagiri, Divyagiri, Katsoulis, Ioannis, Lin, Vincent, Barber, Beth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619337/
https://www.ncbi.nlm.nih.gov/pubmed/26498125
http://dx.doi.org/10.1186/s12885-015-1745-4
_version_ 1782397079081975808
author Saltman, Deborah
Barlev, Arie
Seshagiri, Divyagiri
Katsoulis, Ioannis
Lin, Vincent
Barber, Beth
author_facet Saltman, Deborah
Barlev, Arie
Seshagiri, Divyagiri
Katsoulis, Ioannis
Lin, Vincent
Barber, Beth
author_sort Saltman, Deborah
collection PubMed
description BACKGROUND: The prognosis for adult patients with Ph(-) B-precursor acute lymphoblastic leukaemia (ALL) who are refractory to treatment or experience relapse (R/R), is poor; over 90 % of these patients die from the disease, typically within a few months. While there are some national guidelines published for the treatment of adult patients with ALL, and local working group recommendations do exist, there is very little detail and no preferred treatment regimens for adult patients with R/R Ph(-) B-precursor ALL. The aim of this study was to describe current real-world clinical practice in Europe for the management and treatment of adult R/R Ph(–) B-precursor ALL. METHODS: A web-based, double-blind survey was conducted in November/December 2013 in France, Germany, Italy, Spain, and the UK. The survey was developed following consultation with specialist clinicians and a critical review of published literature. Eligible clinicians (15 per country) were board-certified in haemato-oncology or haematology; had at least 4 years of experience in their current role and had treated at least five patients with adult ALL in the 36 months before the survey, including at least one with R/R Ph(−) B-precursor ALL. RESULTS: Clinicians across the five countries consulted 16 guidelines and local working group recommendations for the diagnosis and treatment of R/R Ph(–) B-precursor ALL. Thirty three regimens for salvage therapy were reported; the most frequently cited was augmented hyper-CVAD (15 %), with vincristine the most commonly used agent. Salvage therapy regimens involved a range of agents, and most respondents reported using at least one cytotoxic agent; across respondents 10 different cytotoxic agents were cited. All respondents reported that toxicity was common for the regimens they used to treat R/R Ph(–) B-precursor ALL. CONCLUSIONS: This study provides evidence of current management and treatment patterns of R/R Ph(–) B-precursor ALL in the real-world clinical practice in Europe. The approach to the treatment of R/R Ph(–) B-precursor ALL is heterogeneous, reflecting the lack of any clearly superior chemotherapeutic option, thus it appears that clinicians are trying a wide variety of therapies. These findings show a clear need for effective, tolerable treatments for R/R Ph(–) B-precursor ALL. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-015-1745-4) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4619337
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-46193372015-10-26 Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians Saltman, Deborah Barlev, Arie Seshagiri, Divyagiri Katsoulis, Ioannis Lin, Vincent Barber, Beth BMC Cancer Research Article BACKGROUND: The prognosis for adult patients with Ph(-) B-precursor acute lymphoblastic leukaemia (ALL) who are refractory to treatment or experience relapse (R/R), is poor; over 90 % of these patients die from the disease, typically within a few months. While there are some national guidelines published for the treatment of adult patients with ALL, and local working group recommendations do exist, there is very little detail and no preferred treatment regimens for adult patients with R/R Ph(-) B-precursor ALL. The aim of this study was to describe current real-world clinical practice in Europe for the management and treatment of adult R/R Ph(–) B-precursor ALL. METHODS: A web-based, double-blind survey was conducted in November/December 2013 in France, Germany, Italy, Spain, and the UK. The survey was developed following consultation with specialist clinicians and a critical review of published literature. Eligible clinicians (15 per country) were board-certified in haemato-oncology or haematology; had at least 4 years of experience in their current role and had treated at least five patients with adult ALL in the 36 months before the survey, including at least one with R/R Ph(−) B-precursor ALL. RESULTS: Clinicians across the five countries consulted 16 guidelines and local working group recommendations for the diagnosis and treatment of R/R Ph(–) B-precursor ALL. Thirty three regimens for salvage therapy were reported; the most frequently cited was augmented hyper-CVAD (15 %), with vincristine the most commonly used agent. Salvage therapy regimens involved a range of agents, and most respondents reported using at least one cytotoxic agent; across respondents 10 different cytotoxic agents were cited. All respondents reported that toxicity was common for the regimens they used to treat R/R Ph(–) B-precursor ALL. CONCLUSIONS: This study provides evidence of current management and treatment patterns of R/R Ph(–) B-precursor ALL in the real-world clinical practice in Europe. The approach to the treatment of R/R Ph(–) B-precursor ALL is heterogeneous, reflecting the lack of any clearly superior chemotherapeutic option, thus it appears that clinicians are trying a wide variety of therapies. These findings show a clear need for effective, tolerable treatments for R/R Ph(–) B-precursor ALL. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12885-015-1745-4) contains supplementary material, which is available to authorized users. BioMed Central 2015-10-24 /pmc/articles/PMC4619337/ /pubmed/26498125 http://dx.doi.org/10.1186/s12885-015-1745-4 Text en © Saltman et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Saltman, Deborah
Barlev, Arie
Seshagiri, Divyagiri
Katsoulis, Ioannis
Lin, Vincent
Barber, Beth
Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title_full Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title_fullStr Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title_full_unstemmed Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title_short Management and treatment of relapsed or refractory Ph(−) B-precursor ALL: a web-based, double-blind survey of EU clinicians
title_sort management and treatment of relapsed or refractory ph(−) b-precursor all: a web-based, double-blind survey of eu clinicians
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619337/
https://www.ncbi.nlm.nih.gov/pubmed/26498125
http://dx.doi.org/10.1186/s12885-015-1745-4
work_keys_str_mv AT saltmandeborah managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians
AT barlevarie managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians
AT seshagiridivyagiri managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians
AT katsoulisioannis managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians
AT linvincent managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians
AT barberbeth managementandtreatmentofrelapsedorrefractoryphbprecursorallawebbaseddoubleblindsurveyofeuclinicians