Feasibility And Outcome Of Late Intensification With Native L-Asparaginase For Acute Lymphoblastic Leukemia In The Elderly: A Single Center Experience

Background: The prognosis of Philadelphia-negative Acute Lymphoblastic Leukemia (Ph-neg ALL) in patients over 55 years of age is dismal. The European Working Group for Adult ALL (EWALL) backbone, adapted for elderly patients, reported a poor 3 year overall survival (3y-OS) of about 24% due to high relapse rates. Many attempts to improve this outcome have failed due to increased toxicity. In a report, the French Group for Research on Adult ALL (GRAALL) considered that adjunction of L-Asparaginase (L-Asp) seemed too toxic to be recommended during induction chemotherapy in older patients. The GRAALL-SA2 study recently showed no advantage to the adjunction of erythrocytes encapsulated L-Asp to the EWALL backbone. The question of whether L-Asp could be included in a more intensive consolidation regimen has not been addressed so far.