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A five-drug remission induction regimen with intensive consolidation for
adults with acute lymphoblastic leukemia: cancer and leukemia group B study
8811
RA Larson, RK Dodge, CP Burns, EJ Lee, RM Stone, P Schulman, D Duggan, FR Davey, RE Sobol and SR Frankel
University of Chicago, IL, USA.
The goal of this phase II multicenter clinical trial was to evaluate a new
intensive chemotherapy program for adults with untreated acute
lymphoblastic leukemia (ALL) and to examine prospectively the impact of
clinical and biologic characteristics on the outcome. One hundred
ninety-seven eligible and evaluable patients (16 to 80 years of age;
median, 32 years of age) received cyclophosphamide, daunorubicin,
vincristine, prednisone, and L-asparaginase; 167 patients (85%) achieved a
complete remission (CR), 13 (7%) had refractory disease, and 17 (9%) died
during induction. A higher CR rate was observed in younger patients (94%
for those < 30 years old, 85% for those 30 to 59 years old, and 39% for
those > or = 60 years old, P < .001) and in those who had a
mediastinal mass (100%) or blasts with a T-cell immunophenotype. Eighty
percent of B-lineage and 97% of T-cell ALL patients achieved a CR (P =
.01). The coexpression of myeloid antigens did not affect the response rate
or duration. Seventy percent of those with cytogenetic or molecular
evidence of the Philadelphia (Ph) chromosome and 84% of those without such
evidence achieved a CR (P = .11). Patients in remission received multiagent
consolidation treatment, central nervous system prophylaxis, late
intensification, and maintenance chemotherapy for a total of 24 months.
After a median follow-up time of 43 months, the median survival for all 197
patients is 36 months; the median remission duration for the 167 CR
patients is 29 months. Favorable pretreatment characteristics relative to
remission duration or survival are younger age, the presence of a
mediastinal mass or lymphadenopathy, a white blood cell count (WBC) less
than 30,000/microL, L1 morphology, T or TMy immunophenotype, and the
absence of the Ph chromosome. The estimates of the proportion surviving at
3 years are 69% for patients less than 30 years old, 39% for those 30 to 59
years old, 89% for those who had a mediastinal mass, 59% with WBC less than
30,000/microL, 63% with L1 morphology, 69% for T or TMy antigen expression,
and 62% for those who lack the Ph chromosome. Fifteen patients (8%) had no
unfavorable prognostic factors and have an estimated probability of
survival at 5 years of 100% (95% confidence interval, 77% to 100%). This
intensive chemotherapy regimen produces a high remission rate and a high
proportion of durable remissions in adults with ALL.
Volume 85,
Issue 8,
pp. 2025-2037,
04/15/1995
Copyright © 1995 by The American Society of Hematology
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