title: Experience with vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy in adults with refractory acute lymphocytic leukemia.
abstract: Sixty-four adult patients with refractory acute lymphocytic leukemia (ALL) received salvage therapy with the vincristine, doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH), and dexamethasone (VAD) regimen consisting of induction chemotherapy with the three agents followed by multiple-agent maintenance therapy for 2 years. Overall, 25 patients (39%) achieved complete remission. The median remission duration was 28 weeks with 20% of these patients remaining disease-free at 2 years. The median overall survival was 23 weeks. Prognostic factors associated with differences in remission rates included patient performance status, hemoglobin and platelet levels, and degree of peripheral and marrow blastosis. Factors related to differences in survival were patient age and performance status, hemoglobin and platelet levels, percentage of peripheral blasts, and albumin and bilirubin levels. The toxicity of the regimen was minimal, with 33% of patients requiring hospitalization because of febrile episodes of unknown origin (17%) or documented infections (16%). Therapy-related mortality occurred in four patients (6%). We conclude that the VAD program has significant antileukemic efficacy and acceptable toxicity in adult salvage ALL.
authors.affiliation: Department of Hematology, University of Texas, MD Anderson Cancer Center, Houston 77030.
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: R S
authors.initials: RS
authors.lastname: Walters
authors.forename: M J
authors.initials: MJ
authors.lastname: Keating
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: K B
authors.initials: KB
authors.lastname: McCredie
authors.forename: E J
authors.initials: EJ
authors.lastname: Freireich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin