Estimatetd 8‐year survival of more than 40% in a population‐based study of 79 adult patients with acute lymphoblastic leukaemia

Abstract

We report 11 years experience with a modified version of a chemotherapy programme in use at the MRC Leukaemia Unit from 1982 to 1984, supplemented by allogeneic bone marrow transplantation in first relapse or second or later remission from 1985. 79 consecutive patients aged 15-60 years with newly diagnosed acute lymphoblastic leukaemia (ALL) were given induction chemotherapy. This included a standard DAT course (daunorubicin, cytarabine and thioguanine) applied as in acute myelogenous leukaemia approximately midway in the induction programme. A 3-year rotating maintenance programme consisted of combinations of cytotoxic drugs used in the induction therapy. CNS prophylaxis did not include CNS irradiation. Allogeneic BMT was not performed in first remission. The overall complete remission (CR) rate was 82% (65/79). 26 patients relapsed (seven first in the CNS). Seven patients underwent allogeneic BMT of whom six are alive and well with a mean observation time of 32 months (range 4-99 months) after transplantation. Three patients died in first CR. Estimated 5- and 8-year overall survival was 51% (95% confidence interval (CI) 39-63) and 47% (CI 33-61). For patients who reached CR, the corresponding figures were 63% (CI 50-76) and 57% (CI 41-73). Estimated disease-free survival in the remitters was 54% (CI 40-68) at 5 years and 44% (CI 28-60) at 8 years. Patient age below 25 years and white cell count below 15 x 10(9)/l at presentation were both found to improve the chance of overall survival.

Patterns of care and survival for adolescents and young adults with acute leukaemia – a population-based study

“…It is widely recognized that survival rates among adults are substantially lower (Proctor, 1994;Chessells et al, 1998). Recent population-based studies of adults relate to fairly small numbers of cases, however (Gorst and Johnson, 1992;Evensen et al, 1994;Proctor et al, 1995;Youngson et al, 1995), and none quoted results specifically for the age group immediately following childhood.…”

Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy

“…Treatment strategies of HL and NHL at the NRH for the period 1980 -2002 have been described earlier (Hagemeister et al, 1987;Merk et al, 1991;Evensen et al, 1994;Abrahamsen et al, 1996;Holte et al, 1996;Hollender et al, 2000;Aurlien et al, 2001;Seidemann et al, 2001;Sweetenham et al, 2001;Blystad et al, 2001aBlystad et al, , 2001bSmeland et al, 2004;Kiserud et al, 2007).…”

Treatment outcome in adults with acute lymphoblastic leukemia: 50% long-term disease-free survival

“…[1][2][3][4] We have previously reported favorable outcome for patients less than 60 years of age treated according to our institutional protocol: actuarial 8-year overall survival (OS) 47% and DFS 44%. 5 Actual survival, however, is rarely reported in the medical literature. The purpose of this report is to present the actual 8-year survival for adults with ALL treated in our hospital.…”

“…The protocol has been described in detail elsewhere. 5 Highdose methotrexate was increased from 500 to 1500 mg/m 2 through 1000 mg/m 2 following our previous report, but apart from this dose escalation the protocol has been unchanged during the study period. Patients in 2.complete remission (2.CR) with a suitable donor were allografted as part of salvage therapy.…”