A modified shortened chemotherapy for reinduction therapy in relapsed adult Ph⁻ acute lymphoblastic leukemia

Remission rates remain low among adult patients with relapsed Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph⁻ ALL). The standard 4-week reduction chemotherapy regimen cannot be administered due to serious hematopoietic toxicity and infection during induction therapy, which can decrease the elimination of blast cells. In this study, a modified shortened P-CIOD chemotherapy protocol (comprising pegaspargase, cyclophosphamide, idarubicin, vindesine, and dexamethasone) was used as a reinduction therapy for relapsed Ph⁻ ALL. Remarkably, 80% (4 out of 5) of the patients achieved complete remission (CR) with minimal residual disease (MRD) negativity and without treatment-related mortality. Two patients were lost to follow-up after consolidation treatment, while the remaining three patients survived. The longest disease-free survival (DFS) recorded was 27 months. The results suggest that the novel protocol shows a favorable second complete remission (CR2) with low toxicity for adult patients with relapsed Ph⁻ ALL.