Treatment of acute lymphoblastic leukemia in adults with intensive induction, consolidation, and maintenance chemotherapy

Hussein, KK; Dahlberg, Steve; Head, David R.; Cc, Waddell; Dabich, Lyubica; Jk, Weick; Morrison, Francis S.; Jh, Saiki; Metz, Earl N.; Rivkin, S E

doi:10.1182/blood.v73.1.57.bloodjournal73157

Cited by 60 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mild induction therapy employed in this trial induced a 79 . 3% CR rate, comparable to the rate recorded both in single or multi-institutional trials, which employed either more intensive conventional induction schedules or unconventional ones (Lister et al, 1978;Fiere et al, 1987;Hoelzer et al, 1989;Hussein et al, 1989;Clarkson et al, 1990;Fiere et al, 1993;Durrant & Richard, 1993;Weiss et al, 1993;Evensen et al, 1994). The second aim of our trial was to evaluate the impact of an early intensive consolidation phase on CR length.…”

Section: Discussionsupporting

confidence: 70%

“…The proposal that adult ALL can be cured through chemotherapy only is becoming a reality. The various therapeutic strategies employed in the past decade enabled 25-35% of these patients to become long-term survivors and possibly to be cured (Schauer et al, 1983;Omura & Raney, 1985;Hoelzer et al, 1989;Hussein et al, 1989;Clarkson et al, 1990;Preti & Kantarjian, 1994). The improvement in the percentage of long-term survivors is often achieved by intensifying the therapeutic regimens, the toxicity of which is not negligible.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The GIMEMA ALL 0183 trial: analysis of 10‐year follow‐up

1996

View full text Add to dashboard Cite

We report the 10-year follow-up of the GIMEMA ALL 0183 trial. From 1983 to 1987, 358 adults with acute lymphoblastic leukaemia (ALL) were entered into this trial, which included a mild induction, an early intensive consolidation, a post-consolidation phase randomized in conventional maintenance (arm A) and in more intensive regimen (arm B). CNS prophylaxis did not include CNS irradiation. The overall complete remission (CR) rate was 79.3% (284/358); 212 patient were randomized (110 in arm A and 102 in arm B). The median overall CR duration was 20 months and the median overall survival (OS) 21 months; both curves reach a plateau after 6 years; at 10 years 25% of patients were projected to be in long-term remission and survivors. The median disease-free survival (DFS) was 17 months, at 10 years 27% and 28% of patients were DFSs in arm A and in arm B respectively. In multivariate analysis age, WBC count and L2 FAB subtype were found to significantly influence OS and DFS. With regard to our previous report OS appears to linearly correlate with initial WBC count and age (P = 0.0002 and P = 0.042 respectively). 195 (68.7%) patients relapsed (only 25 had isolated CNS). The overall second CR rate was 56.5%; 23 patients underwent transplantation (12 BMT and 11 ABMT). Post-relapse survival was found to be influenced by the duration of first CR.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

The GIMEMA ALL 0183 trial: analysis of 10‐year follow‐up

1996

View full text Add to dashboard Cite

show abstract

“…Furthermore, this trial is without an upper age limit; thus the patient population has a relatively high median age (42 years). Age is recognized by many authors as one of the most important prognostic factors both for CR rate and outcome (Hoelzer et al , 1988; Hussein et al , 1989; Kantarjian et al , 1994; Larson et al , 1995). Our study showed an estimated 3 year CCR of 36% and 5 year CCR of 30%, with better results for pre‐B ALL compared with T‐ALL.…”

Section: Discussionmentioning

confidence: 99%

High‐dose cytarabine in upfront therapy for adult patients with acute lymphoblastic leukaemia

et al. 2002

View full text Add to dashboard Cite

Summary. In this national study, we have evaluated a new intensive chemotherapy protocol for adult patients with untreated acute lymphoblastic leukaemia (ALL). One hundred and fifty-three patients with median age 42 years received induction therapy with high-dose cytarabine (Ara-C), cyclophosphamide, daunorubicin, vincristine and betamethasone. A high complete remission (CR) rate (90%) was achieved in patients < 60 years compared with 70% in patients > 60 years (P ¼ 0AE004). The estimated 3 year overall survival for all patients was 29% (CI 21-36%) and the estimated continuous complete remission (CCR) at 3 years for the patients achieving CR according to the protocol was 36% (CI 27-45%). A favourable pretreatment characteristic was pre-B phenotype, especially for patients < 40 years without any high-risk factor, with an estimated CCR at 3 years of 62% (CI 41-82%). Stem cell transplantation (SCT) as post-remission therapy, mainly for high-risk patients, gave an estimated 3 year disease free survival (DFS) after SCT of 39% (CI 24-54%). No significant differences in DFS could be found between autologous, related or unrelated donor transplantation. We conclude that this intensive protocol resulted in a high CR rate combined with acceptable side-effects and a favourable CCR for patients with pre-B ALL.

show abstract

“…Treatment results in elderly ALL patients are worse than those observed in younger adults [14,31]. Older age is predictive of shorter remission duration and survival in most adult ALL studies [31][32][33][34][35]. Several factors may account for this, such as an increased toxicity of therapy results with higher morbidity and mortality during induction therapy or an incomplete drug administration and extended intervals between cycles leading to inferior long-term results.…”

Section: Discussionmentioning

confidence: 99%

Acute lymphoblastic leukemia in the elderly: The Edouard Herriot hospital experience

et al. 2001

View full text Add to dashboard Cite

Data on all patients with acute lymphoblastic leukemia (ALL) aged 60 or older, referred to our institution over a 18-year period, were studied to determine the incidence and range of clinical and biological subtypes, and the outcome of different therapeutic approaches. Sixty-nine ALL cases (median age: 68 years) were diagnosed between 1980 and 1998 (18% of all adult ALL seen during this period). Ten of them (14%) had a past history of previous malignancy. Karyotypic analysis was performed successfully in 42 cases. Ten patients were diagnosed as Philadelphia chromosome positive (Ph + ) ALL. Immunophenotyping was performed in 63 cases. Fifty-six patients had B-cell lineage ALL. T lymphoid markers were observed only in 5 cases. Co-expression of myeloid markers was observed in 19% of tested cases. Five patients died before any chemotherapy could be given. All other patients received "curative" treatment according to different protocols used during the period of study. Overall complete remission (CR) rate of these patients was 62% (95% confidence interval (CI): 50-74%). Thirty-nine patients achieved CR after one course of chemotherapy and 4 patients after salvage therapy. Median disease-free survival (DFS) of the entire cohort was 8.3 months (95% CI: 5-12.8 months) and median overall survival was 7 months (95% CI: 6-10 months). In multivariate analysis, the presence of hemorrhage (P = 0.02) was a poor prognostic for CR achievement. Higher WHO performance status (P = 0.003) and the presence of hemorrhage (P = 0.01) at diagnosis were poor prognostics for overall survival. When patients were stratified into three groups according to the time of admission, survival appeared significantly longer for patients admitted between July 1992 and December 1998 (median overall survival at 10 months) than for patients admitted before July 1992 (P = 0.04). "Age-adapted" therapy appeared superior to "young adult-like" therapy in terms of CR rate (96% versus 60%; P = 0.007). However, "age-adapted" therapy did not show any advantage in terms of DFS or overall survival, making the difference in CR rates questionable. We conclude that the pejorative overall outcome in elderly ALL points to the need for new therapeutic trials taking into account the specific characteristics of ALL in this age group. Am. J. Hematol. 67:73-83, 2001.

show abstract

Treatment of acute lymphoblastic leukemia in adults with intensive induction, consolidation, and maintenance chemotherapy

Cited by 60 publications

References 22 publications

The GIMEMA ALL 0183 trial: analysis of 10‐year follow‐up

The GIMEMA ALL 0183 trial: analysis of 10‐year follow‐up

High‐dose cytarabine in upfront therapy for adult patients with acute lymphoblastic leukaemia

Acute lymphoblastic leukemia in the elderly: The Edouard Herriot hospital experience

Contact Info

Product

Resources

About