Long-Term Survival in Acute Lymphoblastic Leukaemia in Adults Treated according to the LALA 87 Protocol

Abstract

Background: Between January 1989 and July 1995, a prospective study of the therapeutic efficacy of the LALA 87 protocol in adult acute lymphoblastic leukaemia (ALL) has been conducted. Methods: A total of hundred and twelve patients with ALL have been analysed. The median age of the patients was 40 years (range: 15–65), the gender ratio (M/F) was 66/46, and the morphologic FAB (French-American-British) profile was L1 in 30 (26.9%) patients, L2 in 71 (63.3%) and L3 morphology in 11 (9.8%) of the patients. The LALA 87 protocol includes five phases: induction, consolidation, reinforcement, maintenance and central nervous system (CNS) prophylaxis with intrathecal methotrexate and irradiation. The induction phase comprised daunorubicin 50 mg/m² (days 1–3), cyclophosphamide 600 mg/m² (days 1 and 8), vincristine 1.5 mg/m² (on days 1, 8, 15 and 22) and daily oral prednisone on days 1–21. Maintenance therapy was given for 2 years and consisted of different drugs as reinforcement, daily 6-mercaptopurine and weekly methotrexate. Results: Complete remission (CR) was achieved in 81 (72.3%) of the patients. The causes of induction failure were partial response in 10 (8.9%), and hypoplastic death in 12 patients (10.7%), and 9 were non-responders (8.0%). Of the 81 patients who achieved CR, 62 relapsed (76%). Among the relapsed patients, 9 developed CNS disease in spite of CNS prophylaxis during induction chemotherapy. Median follow-up for the living patients was 110 months. Median disease-free survival (DFS) was 16 months; 19 patients are still in remission with an estimated 10-year DFS (24%). Adverse prognostic factors were >50 years of age, immunologic subtype and cytogenetic profile. Conclusion: The results support the strategy of applying more effort and other treatment modalities in the therapy of ALL.

Adolescents and young adults with acute lymphoblastic leukemia have a better outcome when treated with pediatric‐inspired regimens: Systematic review and meta‐analysis

“…Seventeen potentially relevant full text articles were retrieved for further evaluation [11–27]. Of these, nine were excluded [19–27]. Three additional studies were identified by searching conference proceedings [28–30] (Fig.…”

Light and Electron Microscopic Studies on the Possible Protective Effect of Ginger on the Gastric Fundic Mucosa of Adult Male Albino Rats Treated with 5- Fluorouracil

“…Chemotherapy includes the use of cytotoxic agent to eradicate neoplastic cancer cells in different organs [1] . These drugs had different routes of administration with the main purpose of reaching therapeutic level in blood stream [2] 5-fluorouracil is a potent antimetabolite chemotherapeutic medication. It is commonly implicated for treatment of various malignancies such as breast, colorectal, liver, skin, head and neck cancers [3] .…”

Reduction of HLA-DR+ Lymphocytes after Treatment with Enzastaurin in Patients with Metastatic Thyroid Cancer

“…Some cytotoxic agents, such as the anti-metabolite gemcitabine [4] and the anti-folate methotrexate, have a more differential apoptotic effect on lymphocytes. For example, methotrexate primarily induces apoptosis in activated lymphocytes, which has subsequently been exploited in the treatment of autoimmune diseases or hematological malignancies [5][6][7] . Pemetrexed is a novel anti-folate, and while it is approved for the treatment of pleural mesothelioma and non-small-cell lung cancer, its activity has also been investigated in other cancer types [8] .…”