Treatment Outcome of Berlin-Frankfurt-Münster Chemotherapy Induction: Protocol for Adults with Philadelphia Negative Acute Lymphoblastic Leukemia in Oncology Centre, Mansoura University

Background: Acute Lymphoblastic Leukemia (ALL) is a blood cancer involving the overproduction of immature lymphoid cells. Risk factors include advanced age, prior chemotherapy or radiation exposure, and certain genetic disorders. Aim: To evaluate adult patients with Philadelphia, negative ALL received Berlin-Frankfurt-Münster (BFM) Chemotherapy induction protocol. Methods: This study included 98 patients diagnosed with Philadelphia negative ALL by morphology, bone marrow examination, and flowcytometry without prior malignancy with age ranging from 18 to 60 years old. After completion of the BFM induction chemotherapy protocol, patients should be verified to undergo Bone Marrow Aspiration and Trephine Biopsy examination, and morphologic response was assessed along with performing measurable residual disease (MRD) using flowcytometry. Results: B-cell lineage ALL was predominant (77.6%), while T-ALL was present in 22.4% of the cases. All patients began the BFM protocol, but only 52% completed the full course; 36.7% discontinued due to relapse or refractory disease. Prophylactic cranial irradiation was administered to 63.3% of patients. Overall, 58.2% of patients were alive at follow-up. The median overall survival (OS) was 20.1 months, and the median event-free survival (EFS) was 15.15 months. Conclusion: Patients who achieved complete remission had significantly better EFS and OS compared to those who did not. Furthermore, bleeding, cerebrospinal fluid (CSF) infiltration, relapse, and COVID-19 infection were found to significantly impact OS. The study underscored the importance of achieving complete remission (CR) for improved survival outcomes.