feasibility and effectiveness of calgb 10403 protocol in adolescent and young adult patients with acute lymphoblastic leukemia/ lymphoblastic lymphoma: a study at seyed al-shohada hospital, isfahan, iran

Background: acute lymphoblastic leukemia (all) and lymphoblastic lymphoma (lbl) are rare blood cancers with poorer survival in adolescents and young adults (ayas) than in children. pediatric-inspired regimens like calgb 10403 have improved outcomes in ayas. this study evaluated the effectiveness, feasibility, and treatment-related toxicities of calgb 10403 in ayas with all/lbl treated at seyed al-shohada hospital, isfahan, iran, from december 2021 to may 2024. materials and methods: ayas aged 17-39 with newly diagnosed all/lbl (excluding burkitt, ph+, and prior treatment) were included.  baseline characteristics and outcomes of interest (induction response, event-free and overall survivals) were collected.  induction response was assessed via bone marrow (all) or ct scan/biopsy (lbl). minimal residual disease (mrd) was evaluated by flow cytometry. treatment-related toxicities were monitored and graded per ctcae criteria. the feasibility of implementing the calgb 10403 protocol was evaluated by measuring treatment delays. results: seventeen aya patients with newly diagnosed all/lbl (median age 21) were enrolled, mostly male (14/17). fourteen had all, and three had lbl. extramedullary involvement was seen in 29%, including lymphadenopathy, bulky mediastinal masses, and cns involvement. sixteen patients (94%) achieved remission, with no deaths during the induction course. one-year efs and os were 77% and 100%, respectively. common toxicities included hyperbilirubinemia, elevated transaminases, and infections. treatment delays, mainly from non-adherence, occurred in 53%. eight patients achieved mrd negativity after course i. conclusion: this study provides insights into the first iranian experience with the calgb 10403 protocol for ayas with all/lbl, a regimen that has demonstrated encouraging survival outcomes in u.s. trials.