Do they need potent chemotherapeutic regimens such as Hyper-CVAD? What is your opinion about combination of Dasatinib and PEG-Asparaginase for adult patients with ALL, Ph+? Do you think the combination could add to toxicities?
Dr.Akhtari, Are you going to treat patients based on opinions from ResearchGate??!!
Induction of Remission and consolodation-
TKI(imatinib or dasatinib with chemotherapy( vcr, hyper cyclo, L-asp,dexamethason,doxorubicin) After CR, SCT AND maintainance with 6-MP ,MTX
For Goodwin G. Jinesh: I do not treat my patients based on opinion from Reserachgate; however, I am interested to see if clinicians combine PEG-Asparaginase with TKIs. Thanks.
Dr Akhtari
I know You asked about adult patients but re TKIs and PEG-asp the European protocol EsPhALL for children with Ph+ ALL uses Coli asparaginase together with Imatinib and in case of allergy PEG-Asp is recommended at a dose of 1000 Units/m2. Imatinib dose is 300 mg/m2.
In the Nordic countries in this protocol, PEGAsp is given on day 30 concomitantly with Imatinib
Dr. Abrahamsson,
Thank you for your reply which is very helpful. I wonder if you have observed any toxicities, particularly hepatic toxicities, in those patients. Can you send me those protocols? Thanks.
As far as I know no excessive hepatic toxicity has been observed in the protocol. With this chemotherapy backbone and with 6MP/mtx maintenance it is not uncommon with elevated liver enzymes and occasional hyperbilirubinemia though. Children usually tolerate hepatotoxicity from chemotherapy well although VOD may occur during ALL therapy.
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