Results of induction therapy with vincristine and prednisone alone in adult acute lymphoblastic leukemia: Report of 43 patients and review of the literature

Abstract

The complete remission (CR) rate in children with acute lymphoblastic leukemia (ALL) who received vincristine (VCR) plus prednisone (PRED) alone for induction is > 90%, and has not improved with the use of more intensive regimens. In adults with ALL, using the same regimen, a CR rate of only 50% is frequently quoted, and is apparently based mainly on unpublished data on only 13 patients from an early Acute Leukemia Group B protocol. We reviewed the case records of 43 adults with previously untreated ALL seen between July I , 1966 and December 3 I , 1978 who received VCR + PRED alone for induction. A CR rate of 66% was achieved and compares to an overall figure of 61% from 162 patients collected from the literature. The CR rate was age dependent with 21/29 (76%) < 50 years of age achieving a CR compared to 4/19 (29%) who were 2 50 years of age (P < 0.02). The median duration of CR was 8.3 months. For those who achieved a CR, the median survival was 19 months compared to five months for those who either failed to achieve a CR or who achieved only a partial remission (P = 0.004). All patients who achieved a CR received maintenance therapy, and approximately one-half also received CNS prophylaxis with intrathecal methotrexate. The incidence of isolated CNS relapse was 1 1 % in those who received CNS prophylaxis compared to 20% in those who did not.From these data and a review of the literature, we conclude that approximately twothirds of adults with ALL will achieve a CR with the use of VCR + PRED alone. The median duration of CR, however, is < one ycar and the median survival is approximately two years. Whether the use of more intensive induction, consolidation, and maintenance regimens will improve these results remains to be established.

A Comparison of Dexamethasone plus Vincristine versus Standard Regimen in Induction Therapy of Adult Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplantation

“…In 1976, Cancer Journal published an article reporting complete remission achievement by the use of vincristine and prednisone in most of studied adult patients 20 . A 61 % rate of complete remission in adults has also been shown by Takahashi study 21 and was confirmed by a rate of 66% reported by another study published in the same year 19 . According to these findings and presumptions, here, in Hematology-Oncology and Stem Cell Transplantation Research Center, Sharitai Hospital, eligible patients were offered to undergo HSCT with an induction regimen consisting of dexamethasone and vincristine and the outcomes were retrospectively compared with the outcomes of HSCT following standard induction therapy.…”

“…Later studies revealed lower CR rate as 61% (11 from 18 patients) 21 . Sixty-six percent of adults (total n=43) obtained complete remission in the study of Hess and Zirkle 19 .The CR rate was age dependent in their study. Comparing to our case-control study, all of 49 patients of our cyto-reduction group which received dexamethasone and vincristine for induction therapy achieved complete remission.…”

“…A review of literature showed that the use of vincristine and prednisone as induction chemotherapy in children with ALL had resulted in 90% complete remission(CR ) 19 and studies on adult patients are rare due to introduction of new chemotherapy drugs. In 1976, Scavino et al used this relatively nontoxic combination in 14 adult patients and 13 attained complete remission with lower complications and duration of hospitalization 20 .…”

“…Literature shows that administration of only vincristine and prednisone as induction regimen in children suffering from ALL results in more than 90 % CR rate 19 . In 1976, Cancer Journal published an article reporting complete remission achievement by the use of vincristine and prednisone in most of studied adult patients 20 .…”

Guidelines Insights: Acute Lymphoblastic Leukemia, Version 1.2019

“…17 Attempts to identify optimal therapy in this population have included adaptations of palliative regimens including vincristine and corticosteroids, and POMP (6-mercaptopurine, vincristine, methotrexate, and prednisone). [43][44][45][46] Although these regimens are unlikely to generate cure, they can palliate the disease and extend survival, with clinical outcomes similar to those achieved with more intensive protocols. It is important to note that older adults with ALL and multiple comorbidities have not typically qualified for clinical trials.…”