|
|
Blood, 15 July 2006, Vol. 108, No. 2, pp. 465-472.
Prepublished online as a Blood First Edition Paper on March 23, 2006; DOI 10.1182/blood-2005-11-4666.
 Previous Article | Next Article 
Submitted November 29, 2005
Accepted March 9, 2006
Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis. Results from the International ALL Trial MRC UKALL-XII/ECOG E2993
Hillard M Lazarus*, Susan M Richards, Raj Chopra, Mark R Litzow, Alan K Burnett, Peter H Wiernik, Ian M Franklin, Martin S Tallman, Lucy Cook, Georgina Buck, I J Durrant, Jacob M Rowe, and Anthony H Goldstone
Comprehensive Cancer Center, Case Western Reserve University, Clevelland, OH, USA
Clinical Trial Service Unit, Oxford, United Kingdom
Christie NHS Trust Hospital, Manchester, United Kingdom
Mayo Clinic, Rochester, MN, USA
University of Wales, Cardiff, United Kingdom
Our Lady of Mercy Cancer Center, New York Medical College, Bronx, NY, USA
Glasgow Royal Infirmary, Glasgow, United Kingdom
Northwestern University Feinberg School of Medicine, Chicago, IL, USA
UCL Hospitals, London, United Kingdom
Rambam Medical Center and Technion, Haifa, Israel
* Corresponding author; email: hillard.lazarus{at}case.edu.
Outcome of acute lymphoblastic leukemia (ALL) in adults with central nervous system (CNS) disease at diagnosis is unclear. We treated 1,508 de novo ALL patients with two-phase induction then high-dose methotrexate with L-asparaginase. Patients  50 years in first remission (CR1) with a matched-related donor (MRD) underwent an allogeneic stem cell transplant (SCT); the remainder in CR1 were randomized to an autologous SCT or intensive consolidation followed by maintenance chemotherapy. Philadelphia chromosome (Ph) positive patients were offered a matched unrelated donor (MUD) allogeneic SCT. 77/1508 (5%) patients median age 29 years had CNS leukemia at presentation; 13/77 (17%) were Ph positive ALL. 69/77 (90%) patients attained CR1. 36 patients underwent transplant in CR1 (25 MRD, 5 MUD and 6 autografts). 11/25 MRD remain alive at 21-102 months, 2/5 MUD at 42 and 71 months and 1/6 autologous SCT at 35 months. 7/27 treated with consolidation/maintenance remain in CR1 56-137 months after diagnosis. Overall survival at 5 years was 29% in those with CNS involvement at diagnosis versus 38% (p=0.03) for those without. CNS leukemia in adult ALL is uncommon at diagnosis. Adult Ph negative ALL patients, however, can attain long-term disease-free survival using SCT as well as conventional chemotherapy.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
A. Fielding
The Treatment of Adults with Acute Lymphoblastic Leukemia
Hematology,
January 1, 2008;
2008(1):
381 - 389.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Rowe and A. H. Goldstone
How I treat acute lymphocytic leukemia in adults
Blood,
October 1, 2007;
110(7):
2268 - 2275.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Moorman, C. J. Harrison, G. A. N. Buck, S. M. Richards, L. M. Secker-Walker, M. Martineau, G. H. Vance, A. M. Cherry, R. R. Higgins, A. K. Fielding, et al.
Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial
Blood,
April 15, 2007;
109(8):
3189 - 3197.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-H. Pui
Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment
Hematology,
January 1, 2006;
2006(1):
142 - 146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
