Introduction:

Acute lymphoblastic leukemia (ALL) is characterized by the uncontrolled proliferation of lymphoid precursor cells, most from the B phenotype, which is the result of various cytogenetic mutations and alterations involved in cell division and survival.

Objective:

To evaluate the efficacy of bortezomib in patients with ALL through the measurable residual disease (MRD) outcome at 6 weeks (day +45) and response to induction therapy with chemotherapy in combination with a first-generation proteasome inhibitor.

Material and methods:

This was cross-sectional, observational, retrospective, and analytical study based on clinical records of patients diagnosed with ALL who received induction therapy plus bortezomib, from January 1, 2019, to May 31, 2024, and comparing it to a historic group.

Results:

Twenty patients were included, 60% (n = 12) of whom were male, with an average age of 26 years (range 18-61 years). All cases corresponded to the B phenotype, 85% were negative for BCR: ABL1, without central nervous system infiltration (CNS). After treatment initiation, the most common adverse event was anemia and thrombocytopenia (GIII-GIV) and 30% experienced grade I-II peripheral neuropathy. When compared to the historical record, the odds ratio (OR) to evaluate the treatment response with early response variables, there was no difference (confidence interval [CI] = 0.173-1.630, p = 0.206). In overall survival, there were no statistically significant differences when compared with the historical cohort, OR of 1.538 (CI = 0.502-4.748, p = 0.319).

Conclusion:

The addition of bortezomib to the induction chemotherapy did not show a benefit in the percentage of remissions or the proportion of MRD. It is important to continue exploring new options that can be added to this high-risk group of patients to reduce refractoriness and the proportion of early relapses.

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