title: High-dose Ara-C for remission induction and consolidation of previously untreated adults with ALL or lymphoblastic lymphoma.
abstract: Thirty-two patients with untreated ALL (n = 26) or lymphoblastic lymphoma (n = 6) between 17 and 65 years of age were treated with a short remission induction course with VP16-213, amsacrine, intermediate dose Ara-C for 6 days, prednisone and intrathecal methotrexate, followed by a consolidation course with vincristine, amsacrine, high dose Ara-C for 4 days, prednisone and intrathecal methotrexate. After subsequent cranial irradiation, no further maintenance was planned. However, some patients underwent an allogenic (n = 5) or autologous (n = 5) bone marrow transplantation after the consolidation treatment. Twenty-three of 32 patients (72%) achieved a complete remission. Ten of 13 patients with T-ALL or lymphoma, six of eight patients with pre-B or common ALL, and seven of 11 patients with B-ALL or Burkitt's lymphoma achieved a complete remission. The median duration of remission was 24 months. Overall survival for the whole group was 35% at 5 years. The disease-free survival was 45% at 5 years. Long-term survival for patients with B or T-ALL was approximately 60%, compared with 15% for those with common or pre B-ALL. Short term intensive courses including intermediate or high dose Ara-C during remission and consolidation treatment lead to results comparable to those obtained with long-term maintenance regimens. Our regimen may be sufficient for patients with T or B-ALL. Larger randomized studies are needed to investigate the relative importance of our observations.
authors.affiliation: Department of Hematology, Leiden University Medical Center, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Willemze
authors.forename: J M
authors.initials: JM
authors.lastname: Zijlmans
authors.forename: G J
authors.initials: GJ
authors.lastname: den Ottolander
authors.forename: J C
authors.initials: JC
authors.lastname: Kluin-Nelemans
authors.forename: J H
authors.initials: JH
authors.lastname: Falkenburg
authors.forename: C W
authors.initials: CW
authors.lastname: Starrenburg
authors.forename: J F
authors.initials: JF
authors.lastname: van der Burgh
authors.forename: W E
authors.initials: WE
authors.lastname: Fibbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000677:Amsacrine / Q000008:administration & dosage / Q000592:standards; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000008:administration & dosage / Q000592:standards / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005047:Etoposide / Q000008:administration & dosage / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000592:standards; D008875:Middle Aged; D010865:Pilot Projects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage / Q000592:standards; D012074:Remission Induction; D015996:Survival Rate; D013997:Time Factors; D014750:Vincristine / Q000008:administration & dosage / Q000592:standards
chemical_list: D000677:Amsacrine; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D011241:Prednisone; D008727:Methotrexate