Improved results of an intensified therapy in adult acute lymphocytic leukemia.
Two consecutive studies for adult patients with acute lymphoblastic leukemia without previous treatment were analyzed and compared. Protocol ALL-79 included 137 patients treated with a 'standard therapy' consisting of prednisone, vincristine and daunomycin as induction, CNS prophylaxis with IT chemotherapy and maintenance with 6-mercaptopurine, methotrexate and pulses with vincristine and prednisone. Protocol ALL-82 included 145 patients treated with an 'intensive therapy' consisting of 8 weeks of induction with vincristine, prednisone, daunomycin and L-asparaginase, followed by 6-mercaptopurine, cyclophosphamide and cytosine arabinoside. At 3 months after induction, a 6-week consolidation therapy was given, with vincristine, adriamycin, dexamethasone and L-asparaginase, followed by cyclophosphamide, cytosine arabinoside and 6-mercaptopurine. Rates of complete remission were 80% and 78% for protocols ALL-79 and ALL-82 respectively. The probability of remaining in complete remission at 80 months was 20% and 34%, respectively (p = 0.0014). Median survival for protocol ALL-79 was 14 months, and 34 months for protocol ALL-82; at 80 months the probability of survival is 22% and 35% for the two protocols (P = 0.0024). In protocol ALL-82, the probability of remaining in CR for favorable prognosis patients (age = less than 35 years and WBC = less than 50.000) is 56% at 80 months, and only 8% at 50 months for the unfavorable group (age greater than 35 and/or WBC greater than 50.000) (P = 0.0012). The probability of survival was statistically superior in patients with favorable prognoses, with 54% of them still alive at 60 months compared to only 13% of patients with unfavorable prognoses (P = 0.0085).(ABSTRACT TRUNCATED AT 250 WORDS)
Lluesma-Goñalons
M
M
Argentine Group for Treatment of Acute Leukemia, Buenos Aires.
Pavlovsky
S
S
Santarelli
M T
MT
Eppinger-Helf
M
M
Dorticos Bavea
E
E
Corrado
C
C
Carnot
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D012074:Remission Induction; D012737:Sex Factors; D015996:Survival Rate