Short‐term intensive treatment (V.A.A.P.) of adult acute lymphoblastic leukemia and lymphoblastic lymphoma

Abstract

Increased dosages of cytosine arabinoside (Ara‐C) have been shown to be active in remission induction and consolidation treatment of patients with primary refractory acute lymphoblastic leukemia (ALL) and lymphoblastic non‐Hodgkin's lymphoma (lyNHL). From August 1983 to December 1986 we treated 25 patients with ALL (9) and lyNHL, stage III and IV (16), median age 22 (range 15–48 yr) with a protocol consisting of remission induction with vincristine, prednisone, adriamycine and Ara‐C (1 g/m2 twice daily as 2‐h infusion d1–6) and intrathecal methotrexate, followed by consolidation courses with vincristine, prednisone, adriamycine and Ara‐C (3 g/m2, twice daily as 2‐h infusion d1–4) and intrathecal methotrexate. Some patients received CNS and/or mediastinal irradiation. No maintenance was given. 18 patients (72%) achieved complete remission (5 of the 11 previously treated and 13 of the 14 previously untreated patients). Consolidation courses were given to 17 patients. 5 of them relapsed in the bone marrow (3), skin (1) and CNS plus bone marrow (1) at 5, 5, 6, 6 and 24 months. The duration of complete remission ranged from 5 to 51+ months; the median could not yet be calculated. Short‐term intensive treatment might be a worthwhile approach for ALL and lyNHL.

Treatment of adults with acute lymphoblastic leukemia: Do the specifics of the regimen matter?

“…Some groups have focused on developing regimens with a more intensive induction,1, 2, 18, 19 whereas others have studied intensifying consolidation or maintenance 3, 20‐26. To our knowledge, none of these other intensified regimens have been compared in a prospective randomized fashion; therefore, it is not possible to know with certainty whether any of these approaches increase the likelihood of cure.…”