Pediatric-inspired regimen abrogates the poor prognosis of adult early T-cell precursor acute lymphoblastic leukemia

Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is recognized as a high-risk subtype of T-cell acute lymphoblastic leukemia (T-ALL). While intensified chemotherapy has demonstrated potential benefits, there is a lack of comparative studies evaluating the effectiveness of adult versus pediatric treatment regimens for adult ETP-ALL. We compared the ETP-ALL patients (n = 65) treated with the pediatric-inspired regimen to the historical cohort treated with the adult regimen (n = 44). The results showed that the pediatric-inspired regimen significantly improved the complete remission rate (91% vs. 75%, p = .026). The five-year overall survival was markedly higher in the pediatric-inspired regimen cohort at 66.5% compared to 26.0% in the adult regimen cohort (p < .001). Event-free survival also improved significantly (63.4% vs. 18.5%, p < .001), with lower relapse rates (12.3% vs. 60.7%, p < .001). Multivariate analysis confirmed that ETP-ALL is not inferior to Non-ETP-ALL, suggesting that ETP-ALL should no longer be regarded as a high-risk factor in adult T-ALL.