Comparative Outcomes of Hyper-Cvad Versus Ukall Protocols in the Treatment of Acute Lymphoblastic Leukemia in Adolescents and Adults

Background: Acute lymphoblastic leukemia (ALL) is a heterogeneous hematological malignancy requiring intensive chemotherapy. In Iraq, ALL represents the most common hematological malignancy, contributing to 41% of all leukemia cases. Limited comparative data exist on the outcomes of different protocols in Iraqi patient populations. Objective: To evaluate and compare the clinical outcomes of two chemotherapy regimens—Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and UKALL (United Kingdom Acute Lymphoblastic Leukemia)—in adult patients with newly diagnosed ALL at Baghdad Teaching Hospital. Patients and Methods: This prospective study was conducted from January 2017 to December 2018 and included 60 patients aged ≥14 years with newly diagnosed ALL. Patients were treated with either the UKALL protocol (n=31) or the Hyper-CVAD protocol (n=29) based on clinical judgment. Follow-up assessments included complete remission rate at two months (CR2M), overall complete remission (CR), relapse rate, and mortality. Statistical analysis was performed using SPSS version 25, with survival analysis conducted via the Kaplan-Meier method. Results: The cohort comprised 60 patients (58.3% male) with a mean age of 27.83 ± 14.22 years. B-ALL was diagnosed in 70% (n=42) and T-ALL in 30% (n=18). Philadelphia chromosome positivity was 18.3% (n=11). The Hyper-CVAD protocol demonstrated a significantly higher CR2M rate compared to UKALL (93.1% vs. 67.7%, P=0.014). Overall CR was 89.6% for Hyper-CVAD versus 48.4% for UKALL. Relapse and mortality rates were lower in the Hyper-CVAD group (6.9% and 10.3%, respectively) compared to the UKALL group (16.1% and 19.4%, respectively). In the B-ALL subgroup, Hyper-CVAD achieved an 85.7% CR versus 42.8% with UKALL. In the T-ALL subgroup, Hyper-CVAD achieved a 100% CR versus 60% with UKALL. No statistically significant difference was found between the two protocols in terms of overall survival (OS) (P=0.963). Conclusion: The Hyper-CVAD protocol was associated with significantly higher early and overall complete remission rates compared to the UKALL protocol in this patient cohort. However, this improvement in remission did not translate into a statistically significant difference in overall survival, underscoring the need for longer follow-up and consideration of post-remission strategies like transplantation.