title: The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia.
abstract: Sixty-six adults with refractory acute lymphocytic leukemia received salvage therapy with the 'hyper-CVAD' regimen, consisting of eight courses of alternating intensive chemotherapy with growth factor support, followed by oral maintenance chemotherapy. Their outcome was compared with 63 prognostically similar historical control patients treated with high-dose Ara-C plus mitoxantrone with or without GM-CSF. Overall, the complete response rates were similar in the treatment and control groups (29 of 66 (44%) vs 24 of 63 (38%)). There were more patients in the current study with primary resistant disease (10 of 66 (15%) vs one of 63 (2%), P = 0.006), and conversely fewer patients with secondary resistance (19 of 66 (29%) vs 28 of 63 (44%), P = 0.06). Recovery of granulocyte counts above 500/microl was significantly faster in the current study when compared to high-dose Ara-C-treated patients who were given GM-CSF (20 vs 25 days, P = 0.04). Survival was prolonged in the hyper-CVAD-treated patients, with most of the benefit seen in first salvage patients (42 vs 20 weeks, P = 0.016). When only first salvage patients were considered, there was a significant difference in disease-free survival in favor of hyper-CVAD (52 vs 20 weeks, P = 0.008). The hyper-CVAD regimen is a more effective and less toxic salvage regimen for relapsed acute lymphocytic leukemia than high-dose Ara-C-based regimens.
authors.affiliation: Department of Hematology, The University of Texas MD Anderson Cancer Center, Houston 77030, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Koller
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: D
authors.initials: D
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: M B
authors.initials: MB
authors.lastname: Rios
authors.forename: S
authors.initials: S
authors.lastname: Kornblau
authors.forename: S
authors.initials: S
authors.lastname: Murphy
authors.forename: M
authors.initials: M
authors.lastname: Keating
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001853:Bone Marrow / Q000187:drug effects; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome