High-dose cytarabine in upfront therapy for adult patients with acute lymphoblastic leukaemia.
In this national study, we have evaluated a new intensive chemotherapy protocol for adult patients with untreated acute lymphoblastic leukaemia (ALL). One hundred and fifty-three patients with median age 42 years received induction therapy with high-dose cytarabine (Ara-C), cyclophosphamide, daunorubicin, vincristine and betamethasone. A high complete remission (CR) rate (90%) was achieved in patients < 60 years compared with 70% in patients > 60 years (P = 0.004). The estimated 3 year overall survival for all patients was 29% (CI 21-36%) and the estimated continuous complete remission (CCR) at 3 years for the patients achieving CR according to the protocol was 36% (CI 27-45%). A favourable pretreatment characteristic was pre-B phenotype, especially for patients < 40 years without any high-risk factor, with an estimated CCR at 3 years of 62% (CI 41-82%). Stem cell transplantation (SCT) as post-remission therapy, mainly for high-risk patients, gave an estimated 3 year disease free survival (DFS) after SCT of 39% (CI 24-54%). No significant differences in DFS could be found between autologous, related or unrelated donor transplantation. We conclude that this intensive protocol resulted in a high CR rate combined with acceptable side-effects and a favourable CCR for patients with pre-B ALL.
The Swedish Adult ALL Group, Uppsala University Hospital, Sweden. helene.hallbook@medicin.uas.lul.se
Helene
H
Hallböök
Bengt
B
Simonsson
Thomas
T
Ahlgren
Magnus
M
Björkholm
Jan
J
Carneskog
Gunnar
G
Grimfors
Robert
R
Hast
Karin
K
Karlsson
Eva
E
Kimby
Richard
R
Lerner
Olle
O
Linder
Mats
M
Linderholm
Eva
E
Löfvenberg
Claes
C
Malm
Per-Gunnar
PG
Nilsson
Christer
C
Paul
Leif
L
Stenke
Dick
D
Stockelberg
Ulf
U
Tidefelt
Ingemar
I
Turesson
Ann-Marie
AM
Uden-Blome
Lars
L
Vilen
Anders
A
Wahlin
Ingemar
I
Winquist
Bengt
B
Smedmyr
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000276:immunology; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate
D003561:Cytarabine