Adult Acute Lymphoblastic Leukemia: Insights from Six Years of Clinical Practice in an Egyptian Tertiary Care Center

Despite being an uncommon hematologic malignancy in adults, acute lymphoblastic leukemia (ALL) remains a highly aggressive disease, with long-term survival rates reported between 30% and 40%. A thorough understanding of the biology of the disease is essential for the effective management of ALL, enabling the application of personalized therapeutic strategies, given the heterogeneity of patient presentations. This has further facilitated the development of targeted therapies and the integration of novel therapeutic agents. This study was conducted to evaluate the overall survival, progression-free survival, and relapse patterns among patients diagnosed with acute lymphoblastic leukemia (ALL) who received treatment at the Kasr Al-Ainy Centre of Clinical Oncology and Nuclear Medicine (NEMROCK) during the period spanning January 2015 to December 2020. In this retrospective analysis, 42 adult patients newly diagnosed with ALL between January 2015 and December 2020 were evaluated at the Kasr Al-Ainy Centre of Clinical Oncology and Nuclear Medicine (NEMROCK). These patients received different treatment protocols that shared a common therapeutic foundation but differed in intensity and scheduling adjustments. Ultimately, 35 patients met the inclusion criteria for the final analysis. The median overall survival (OS) across the cohort was 14.4 months (95% CI: 11.5-17.3). Achieving a complete remission (CR) following the first induction cycle was an important prognostic factor, as patients who reached CR showed a median OS of 17.9 months, compared to 5.3 months for patients with refractory disease (P = 0.02). Among patients with B-cell ALL, those presenting with a total leukocyte count (TLC) of less than 30,000 at diagnosis experienced a significantly longer OS (P = 0.03). In addition, the median disease-free survival (DFS) was 13.3 months, with achievement of CR after the initial induction phase showing a statistically significant impact on DFS outcomes (P = 0.005). This study highlights the importance of tailoring treatment approaches based on risk stratification performed before and during the treatment course. In particular, the role of minimal residual disease (MRD) testing has emerged as a critical standard-of-care tool in the management of ALL, guiding therapeutic decisions and improving patient outcomes.