title: Long-term follow-up of intensive ara-C-based chemotherapy followed by bone marrow transplantation for adult acute lymphoblastic leukemia: impact of induction Ara-C dose and post-remission therapy.
abstract: We report single institution outcome of brief, intensive ara-C-based chemotherapy using bone marrow transplantation as primary intensification for untreated adult patients with acute lymphoblastic leukemia (ALL). Overall disease-free and overall survival were inferior to those reported with prolonged chemotherapy modeled on pediatric protocols. Survival and disease-free survival were superior for patients receiving allogeneic BMT compared with chemopurged autologous transplant or maintenance chemotherapy (patients ineligible for or declining BMT). In multivariate analysis, non-L2-FAB, higher ara-C dose, absence of CNS disease, non-Ph1+ karyotype, allogeneic BMT, T cell phenotype, and younger age were associated with improved disease-free survival. Autologous BMT was not superior to chemotherapy, and appears unlikely to provide adequate curative treatment for most adult ALL patients if not followed by maintenance.
authors.affiliation: The Johns Hopkins Oncology Center, 1650 Orleans Street, Baltimore, MD 21231-1000, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Sotomayor
authors.forename: S
authors.initials: S
authors.lastname: Piantadosi
authors.forename: C B
authors.initials: CB
authors.lastname: Miller
authors.forename: J E
authors.initials: JE
authors.lastname: Karp
authors.forename: R J
authors.initials: RJ
authors.lastname: Jones
authors.forename: S D
authors.initials: SD
authors.lastname: Rowley
authors.forename: S H
authors.initials: SH
authors.lastname: Kaufmann
authors.forename: H
authors.initials: H
authors.lastname: Braine
authors.forename: P J
authors.initials: PJ
authors.lastname: Burke
authors.forename: S D
authors.initials: SD
authors.lastname: Gore
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D014182:Transplantation, Autologous
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine