Phase II study of methotrexate, vincristine, pegylated-asparaginase, and dexamethasone (MOpAD) in patients with relapsed/refractory acute lymphoblastic leukemia

Tapan M. Kadia, Hagop M. Kantarjian, Deborah A. Thomas, Susan O'Brien, Zeev Estrov, Farhad Ravandi, Elias Jabbour, Naveen Pemmaraju, Naval Daver, Xuemei Wang, Preetesh Jain, Sherry Pierce, Mark Brandt, Guillermo Garcia-Manero, Jorge Cortes, Gautam Borthakur

Research output: Contribution to journalArticle

Abstract

Newer approaches are needed for the treatment of relapsed and refractory acute lymphoblastic leukemia (ALL). Asparaginase-based regimens are active in the treatment of pediatric ALL and may be important in salvage therapy for adult patients. We conducted a pilot trial combining methotrexate, vincristine, PEGylated-asparaginase, and dexamethasone (MOpAD) in adults with relapsed or refractory ALL. We added tyrosine kinase inhibitors in patients with Philadelphia chromosome positive (Ph+) ALL and rituximab in patients with CD20 positive B-cell ALL. Among 37 patients treated (median age 42 years; median 2 prior therapies), the complete remission (CR) rate was 28% and an overall response rate (ORR) was 39%. The median CR duration was 4.3 months. Patients with Ph+ ALL had CR and ORR of 50% and 67%, respectively and the CR and ORR in patients with T-cell leukemia were 45% and 56%, respectively. The median survival in patients with CR/CRp was 10.4 versus 3.4 months in nonresponders (P=0.02). The most common grade 3 or 4 nonhematologic toxicities were elevations in bilirubin and transaminases, nausea, peripheral neuropathy, and hyperglycemia, which were managed with supportive care, dose adjustments, and interruptions.

Original languageEnglish (US)
Pages (from-to)120-124
Number of pages5
JournalAmerican Journal of Hematology
Volume90
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Asparaginase
Vincristine
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Methotrexate
Dexamethasone
T-Cell Leukemia
Salvage Therapy
Philadelphia Chromosome
Peripheral Nervous System Diseases
Transaminases
Bilirubin
Hyperglycemia
Protein-Tyrosine Kinases
Nausea
B-Lymphocytes
Therapeutics
Pediatrics
Survival

ASJC Scopus subject areas

  • Hematology

Cite this

Phase II study of methotrexate, vincristine, pegylated-asparaginase, and dexamethasone (MOpAD) in patients with relapsed/refractory acute lymphoblastic leukemia. / Kadia, Tapan M.; Kantarjian, Hagop M.; Thomas, Deborah A.; O'Brien, Susan; Estrov, Zeev; Ravandi, Farhad; Jabbour, Elias; Pemmaraju, Naveen; Daver, Naval; Wang, Xuemei; Jain, Preetesh; Pierce, Sherry; Brandt, Mark; Garcia-Manero, Guillermo; Cortes, Jorge; Borthakur, Gautam.

In: American Journal of Hematology, Vol. 90, No. 2, 01.02.2015, p. 120-124.

Research output: Contribution to journalArticle

Kadia, TM, Kantarjian, HM, Thomas, DA, O'Brien, S, Estrov, Z, Ravandi, F, Jabbour, E, Pemmaraju, N, Daver, N, Wang, X, Jain, P, Pierce, S, Brandt, M, Garcia-Manero, G, Cortes, J & Borthakur, G 2015, 'Phase II study of methotrexate, vincristine, pegylated-asparaginase, and dexamethasone (MOpAD) in patients with relapsed/refractory acute lymphoblastic leukemia', American Journal of Hematology, vol. 90, no. 2, pp. 120-124. https://doi.org/10.1002/ajh.23886
Kadia, Tapan M. ; Kantarjian, Hagop M. ; Thomas, Deborah A. ; O'Brien, Susan ; Estrov, Zeev ; Ravandi, Farhad ; Jabbour, Elias ; Pemmaraju, Naveen ; Daver, Naval ; Wang, Xuemei ; Jain, Preetesh ; Pierce, Sherry ; Brandt, Mark ; Garcia-Manero, Guillermo ; Cortes, Jorge ; Borthakur, Gautam. / Phase II study of methotrexate, vincristine, pegylated-asparaginase, and dexamethasone (MOpAD) in patients with relapsed/refractory acute lymphoblastic leukemia. In: American Journal of Hematology. 2015 ; Vol. 90, No. 2. pp. 120-124.
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AU - Thomas, Deborah A.

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AU - Estrov, Zeev

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AU - Jabbour, Elias

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AU - Daver, Naval

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AU - Jain, Preetesh

AU - Pierce, Sherry

AU - Brandt, Mark

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