Comparison of chemotherapy with immunotherapy for maintenance of acute
lymphoblastic leukemia in children and adults
PA Stryckmans, J Otten, MJ Delbeke, S Suciu, D Fiere, J Bury, G Solbu and Y Benoit
Two hundred and seventeen patients, 1-50 yr old, with acute lymphoblastic
leukemia in complete remission were randomized to receive a 1-yr
consolidation chemotherapy of either type P, comprising 7 different drugs,
or type M, consisting of methotrexate interspersed with prednisone and
vincristine. Thereafter, they were randomized a second time to receive a
4-yr maintenance of either chemotherapy or immunotherapy, comprised of
allogeneic blasts and bacillus Calmette- Guerin (BCG). Consolidation P
caused more toxicity than consolidation M. However, comparison between the
consolidation therapies P and M showed no significant difference, neither
for disease-free interval nor for duration of survival. Chemotherapy showed
more lethal toxicity in adults than in children. Comparison between
chemotherapy (C) and immunotherapy (I) as maintenance treatment showed a
significant (p = 0.016) superiority of C for disease-free interval (DFI).
The difference was even more pronounced (p = 0.009) in the group with less
than 8 g/dl of hemoglobin (Hb) at diagnosis before therapy. On the other
hand, for patients with more than 8 g/dl Hb at diagnosis, presumably those
with T- ALL, no difference in DFI was seen. No difference has been seen so
far between maintenance therapies I and C concerning the duration of
survival. The patients who were receiving maintenance I when they relapsed
and who were consequently retreated by chemotherapy, survived longer from
relapse than those patients retreated for relapse while receiving
maintenance C.
Volume 62,
Issue 3,
pp. 606-615,
09/01/1983
Copyright © 1983 by The American Society of Hematology
