Acute lymphoblastic leukemia (ALL) is a hematological
malignancy with different pathological subtypes; Pre- B- cell
ALL (the most common subtype), pre- T- cell ALL, T- cell
ALL, and B- cell ALL . Several chemotherapy regimens
have been used and developed in the treatment of ALL.
The most effective chemotherapy regimen in the treatment
of adult ALL is not yet clear.
The most widely used protocols were cancer and leu-
kemia group B (CALGB) program which consisted of a
ﬁve- agent combination, Group for Research on Adult
Acute Lymphoblastic Leukemia 2003 (GRAALL 2003)
protocol and more recently hyper- CVAD [2, 3]. Moreover,
the Berlin–Frankfurt–Munster (BFM) regimen was mainly
used in pediatric ALL and can be considered for young
adults with ALL .
The hyper- CVAD regimen (hyperfractionated cyclo-
phosphamide, vincristine, doxorubicin [Adriamycin],
and dexamethasone)/HD MTX and Ara- C (high- dose
methotrexate and cytarabine) are used widely in many
institutions [5, 6]. The MD Anderson Cancer Center
(MDACC) study reported a complete response (CR)
rate of 92%, 5- year overall survival of 38% and
progression- free survival (PFS) of 66% for adult patients
with ALL [7, 8].
Effectiveness of modiﬁed hyper- CVAD chemotherapy
regimen in the treatment of adult acute lymphoblastic
leukemia: a retrospective experience
, Mohsen Rajaeinejad
, Manoutchehr Keyhani
, Mohammad Zokaasadi
Mohammad Mehdi Dehghani Firoozabadi
AJA Cancer Epidemiology Research and Treatment Center (AJA- CERTC), AJA University of Medical Sciences, Tehran, Iran
Hematology and Oncology Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use,
distribution and reproduction in any medium, provided the original work is properly cited.
Acute lymphoblastic leukemia, modiﬁed
Hyper-CVAD, survival analysis
Mohammad Mehdi Dehghani Firoozabadi,
AJA Cancer Epidemiology Research and
Treatment Center (AJA- CERTC), AJA
University of Medical Sciences, West Fatemi
Avenue, Shahid Etemadzadeh Street, 501
army hospital, Tehran, Iran.
No funding information provided.
Received: 26 October 2017; Revised: 11
December 2017; Accepted: 14 December
Cancer Medicine 2018; 7(3):594–599
Several chemotherapy regimens have been developed for the treatment of acute
lymphoblastic leukemia (ALL), but relapse still presents the most common ob-
stacles to attaining long- term survival. The hyper- CVAD (hyperfractionated
cyclophosphamide, vincristine, doxorubicin, and prednisolone)/HD MTX and
Ara- C (high- dose methotrexate and cytarabine) chemotherapy regimen was ﬁrst
started in the MD Anderson Cancer Center as an intensive regimen for adult
patients with ALL. The purpose of this study was to evaluate the effectiveness
of a modiﬁed hyper- CVAD protocol. We used hyper- CVAD as consolidation/
maintenance after remission induction with daunorubicin, vincristine, and pred-
nisolone (and cyclophosphamide for T- cell ALL only) rather than standard
hyper- CVAD in order to reduce treatment complications. This study was con-
ducted as a retrospective review of medical records of ALL patients at 501 army
hospital, Tehran, Iran, from 2005 to 2015. Three hundred and one patients
underwent modiﬁed hyper- CVAD chemotherapy regimen. Complete remission
and overall survival (OS) rates were measured as primary endpoints. Two hun-
dred and forty- six (81.7%) reached complete remission (CR) during the ﬁrst
6 months of treatment, and 55 patients (18.3%) did not reach CR. The 5- year
OS rate was 51.8% (95% CI (conﬁdence interval): 45.1–57.8%). Modiﬁed hyper-
CVAD regimen is an efﬁcient intensive chemotherapy regimen for consolidation/
maintenance of adults with newly diagnosed ALL and has an acceptable 5- year
overall that is comparable to standard hyper- CVAD regimen.