Adult acute lymphoblastic leukaemia: A study of prognostic features and response to treatment over a ten year period

Abstract

Summary Between 1974 and 69 adults with acute lymphoblastic leukaemia (ALL) were treated with two different protocols. Fifty-four (78%) of the patients entered complete remission (CR); 27 of these then received a consolidation protocol consisting of daunorubicin, cytosine arabinoside and 6-thioguanine, followed by two courses of intravenous methotrexate 500 mg m2 with folinic acid rescue. All patients received intrathecal methotrexate and cranial irradiation (24 Gy) followed by maintenance therapy with 6-mercaptopurine and methotrexate for at least 2 years. The median survival for all patients was 23 months from the time of presentation with an actuarial 5-year survival of 21%. The actuarial chance of surviving 5 years in CR for patients receiving the consolidation protocol was 38% compared to 19% for patients receiving no consolidation (P=NS). Only patient age and white cell count at presentation were found to influence the chance of achieving CR and the chance of overall survival. The presence or absence of c-ALL antigen did not influence prognosis. Patients younger than 35 years with low white cell counts at presentation (< O x 109 1 -1) had a particularly good prognosis but no patient with T-ALL and no patient older than 50 years old at diagnosis survived more than 18 months.

Immunophenotypic Classification of Lymphoblastic Leukaemia and Lymphocytic Lymphoma — An Experience in the Southwestern Area of the Cape Province of South Africa

“…Thirdly, in considering survival in patients who achieved CR, age was a factor favourable for remission duration; our experience is consistent with that reported by others (5,10,28,33). The second sig-nificant prognostic factor was the FAB subtyping in which L1 was better than L2.…”

Adult acute lymphoblastic leukaemia

“…For patients with low-risk (see Section 5.5) ALL, postremission consolidation (see Section 6.2.1) chemotherapy within the therapeutic program of conventional dose chemotherapy is standard treatment on a type C basis [238,243,244,248,250,265,279,288,305,309,407]. Prolonged maintenance therapy (see Section 6.2.3) after the consolidation phase is standard therapy on a type C basis, except for B-ALL.…”

“…For intermediate-risk patients (see Section 5.5), standard treatment on a type C basis [238,243,244,248,250,259,265,275,279,288,305,309,407] is the use of innovative intensified consolidation programs (see Section 6.2.1). Inclusion in these regimens of high dose cytosine arabinoside (4-12 doses at 1-3 g/m 2 ), high dose methotrexate (usually 6-8 g/m 2 ) or high dose etoposide is suitable for individual clinical use on a type 3 level of evidence [238,279,304,308,408].…”

High dose cytosine arabinoside in the initial treatment of adults with acute lymphoblastic leukaemia

“…However, the addition of high-dose ara-C does appear to have improved the prognosis of patients with 'poor risk' prognostic factors, i.e. those with a high blast cell count (Barnett et al, 1986;Amadori et al, 1980;Baccarani et al, 1982;Gingrich et al, 1985;Lazzarino et al, 1982;Marcus et al, 1986;Clarkson et al, 1985) and those with T-cell ALL (Bitran, 1978;Baccarani et al, 1983;Lister et al, 1979). These results are consistent with the findings of two large studies in which the use of intensive remission induction and consolidation therapy has resulted in patients with T-ALL having a better prognosis than those with C-ALL (Clarkson et al, 1985;Hoelzer et al, 1988).…”