title: Intensive therapy for adult acute lymphoblastic leukemia: preliminary results of the idarubicin/vincristine/L-asparaginase/prednisolone regimen.
abstract: Between June 1991 and September 1992, 80 patients with adult acute lymphoblastic leukemia (ALL) (newly diagnosed, n = 68; relapsed or refractory ALL, n = 7; lymphoid blast transformation of Philadelphia chromosome-positive chronic myelogenous leukemia [LT-CML], n = 5) were managed with a combination regimen consisting of idarubicin 36, 20, or 10 mg/m2 plus vincristine, L-asparaginase, and prednisolone (IVAP-1, -2, -3). Three patients with LT-CML and four with relapsing ALL had a complete remission. In the group of newly diagnosed patients aged 15 to 60 years treated with IVAP-1, the complete remission rate was only 44% due to the high incidence of toxic deaths. In contrast, 39 of 44 cases who subsequently received IVAP-2 achieved a complete remission (89%, P = .001), as did 62% of elderly patients who received IVAP-3. Hematologic and nonhematologic toxicity was significantly reduced with IVAP-2 compared with IVAP-1. The use of recombinant human granulocyte colony-stimulating factor in 24 patients was not associated with a reduced duration of granulocytopenia less than 0.5 x 10(9)/L, although there was a lower incidence of documented infections in patients receiving granulocyte colony-stimulating factor than in controls. Post-remission intensification with idarubicin-based courses, high-dose therapy with autologous bone marrow stem cell rescue, and rotational weekly therapy was feasible and its toxicity was manageable. These preliminary findings indicate that IVAP-2 (idarubicin 20 mg/m2) is a highly effective and well-tolerated regimen for remission induction of adult ALL.
authors.affiliation: Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bassan
authors.forename: R
authors.initials: R
authors.lastname: Battista
authors.forename: P
authors.initials: P
authors.lastname: Viero
authors.forename: E
authors.initials: E
authors.lastname: Pogliani
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Lambertenghi-Deliliers
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
authors.forename: A
authors.initials: A
authors.lastname: D'Emilio
authors.forename: M
authors.initials: M
authors.lastname: Buelli
authors.forename: G
authors.initials: G
authors.lastname: Borleri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000276:immunology / Q000628:therapy; D011239:Prednisolone / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000627:therapeutic use; D012074:Remission Induction; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D011239:Prednisolone; D001215:Asparaginase; D015255:Idarubicin