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Prognostic factors in a multicenter study for treatment of acute
lymphoblastic leukemia in adults
D Hoelzer, E Thiel, H Loffler, T Buchner, A Ganser, G Heil, P Koch, M Freund, H Diedrich and H Ruhl
Universitatskliniken, Frankfurt, Ulm.
In a prospective multicenter study, 368 acute lymphoblastic leukemia (ALL)
patients aged 15 to 65 years were treated with an intensified induction and
reinduction regimen; 272 (73.9%) achieved complete remission (CR). The
median remission duration (MRD) is 24.3 months, and the probability of
being in continuous CR (CCR) at greater than 5 years is .37. The median
survival for all 368 patients is 27.5 months, and the probability of being
alive at 5 years is .39. For the 272 patients in remission the median
survival is 58.4 months, and the probability of being alive at 5 years is
.49. A lower CR rate was seen for patients with bleeding at diagnosis or
with splenomegaly/hepatosplenomegaly. The prognostic factors unfavorable
for remission duration were time to CR greater than 4 weeks v less than 4
weeks (P = .0002), age greater than 35 years v less than 35 years (P =
.0008), leukocyte count greater than 30,000/microL v less than
30,000/microL (P = .0112), and null ALL v common ALL (c-ALL)/T cell ALL
(T-ALL) (P = .05). The remission duration correlated strongly (P = .0001)
with the number of these independent prognostic factors. In patients with
none of these adverse factors the MRD has not yet been reached, with one
adverse factor the MRD is 21.9 months, and with two or three adverse
factors the MRD is only 9.6 months. For the immunologic subtype T-ALL, the
probability of being in CCR at greater than 5 years is .55; for c-ALL, .34;
and for null ALL, .24. According to these results, patients were stratified
into a low- risk group with a CCR rate of .62 and a high-risk group with a
CCR rate of .28, with the latter now allocated to either further
chemotherapy or bone marrow transplantation in first remission.
Volume 71,
Issue 1,
pp. 123-131,
01/01/1988
Copyright © 1988 by The American Society of Hematology
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