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Treatment of adult acute lymphoblastic leukemia with intensive cyclical
chemotherapy: a follow-up report
CA Linker, LJ Levitt, M O'Donnell, SJ Forman and CA Ries
Department of Medicine, University of California, San Francisco.
We treated 109 patients with adult acute lymphoblastic leukemia (ALL)
diagnosed by histochemical and immunologic techniques. Patients were
excluded only for age greater than 50 years and Burkitt's leukemia.
Treatment included a four-drug remission induction phase followed by
alternating cycles of noncrossresistant chemotherapy and prolonged oral
maintenance therapy. Eighty-eight percent of patients entered complete
remission. With a median follow-up of 77 months (range, 48 to 111 months),
42% +/- 6% (SEM) of patients achieving remission are projected to remain
disease-free at 5 years, and disease-free survival for all patients entered
on study is 35% +/- 5%. Failure to achieve remission within the first 4
weeks of therapy and the presence of the Philadelphia chromosome are
associated with a 100% risk of relapse. Remission patients with neither of
these adverse features have a 48% +/- 6% probability of remaining in
continuous remission for 5 years. Patients with T-cell phenotype have a
favorable prognosis with 59% +/- 13% of patients achieving remission
remaining disease-free compared with 31% +/- 7% of CALLA-positive patients.
Intensive chemotherapy may produce prolonged disease-free survival in a
sizable fraction of adults with ALL. Improved therapy is needed, especially
for patients with adverse prognostic features.
Volume 78,
Issue 11,
pp. 2814-2822,
12/01/1991
Copyright © 1991 by The American Society of Hematology
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