title: Treatment of relapsed or refractory adult acute lymphocytic leukemia.
abstract: Sixty-six adult patients were treated for relapsing or refractory acute lymphocytic leukemia (ALL). The induction treatment consisted in a (1) first phase with vindesine 3 mg/m2 intravenously (IV) on days 1, 8, and 15; daunorubicin 45 mg/m2 IV on days 1, 8, and 15; erwinia-asparaginase 10,000 U/m2 IV on days 7, 8, 14, and 15; and prednisone 60 mg/m2 orally on days 1 to 21 and a (2) second phase with cytarabine 3000 mg/m2 as a 3-hour infusion two times a day on days 1 to 4 (in patients greater than 50 years of age we used 1000 mg/m2), and etoposide 100 mg/m2 IV on days 1 to 5. Side effects of induction Phase I were predominantly hematologic with subsequent infections. In Phase II, some patients additionally had gastrointestinal, cutaneous, ocular, and hepatic toxicity. Five patients died during Phase I and another died during Phase II. Five of these patients had T-cell ALL. Thirty-four (64%) of 54 patients in their first relapse had a complete remission (CR) with a median disease-free survival (DFS) of 2.9 months. The median overall survival (OAS) was 6.6 months. Seven of 12 patients with primary refractory disease, a second relapse, or relapse after bone marrow transplantation (BMT) had a CR. The CR rate and survival after first relapse was significantly better in patients with a preceding CR of more than 18 months compared with those with a shorter preceding remission. The leukocyte count was a second significant but not independent risk factor. There was a negative correlation between the leukocyte count and the duration of the preceding CR. The duration of the preceding CR was the major prognostic factor for survival in multivariate analysis. Twenty-two patients received BMT. None of nine patients with autologous BMT is alive and disease-free; 5 of 13 who underwent allogeneic BMT are. It was concluded that this treatment efficiently induced remission with tolerable toxicity. The remission duration should be improved by optimized consolidation treatment.
authors.affiliation: Abteilung Hämatologie und Onkologie, Medizinische Hochschule, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Freund
authors.forename: H
authors.initials: H
authors.lastname: Diedrich
authors.forename: A
authors.initials: A
authors.lastname: Ganser
authors.forename: M
authors.initials: M
authors.lastname: Gramatzki
authors.forename: G
authors.initials: G
authors.lastname: Heil
authors.forename: A
authors.initials: A
authors.lastname: Heyll
authors.forename: M
authors.initials: M
authors.lastname: Henke
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.forename: R
authors.initials: R
authors.lastname: Haas
authors.forename: R
authors.initials: R
authors.lastname: Kuse
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000601:surgery; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction; D014751:Vindesine / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D005047:Etoposide; D001215:Asparaginase; D014751:Vindesine; D011241:Prednisone; D003630:Daunorubicin