Treatment outcome of adult acute lymphocytic leukemia with VPD(L) regimen: analysis of prognostic factors.
BACKGROUND
Because of the relative paucity of data regarding the clinical outcome in adult patients with acute lymphocytic leukemia (ALL) in Korea, we analyzed clinical courses in adult ALL patients treated with VPD (L) regimen (vincristine, prednisolone, daunorubicin, L-asparaginase) at the Seoul National University Hospital, and evaluated prognostic factors influencing the outcome.


METHODS
Patients with ALL newly diagnosed between October 1994 and June 2000 at our hospital were analyzed retrospectively. Fifty-three patients were evaluable. Induction chemotherapy consisted of VPD with (46 cases) or without L-asparaginase (7 cases). After complete remission (CR), consolidation therapy, CNS prophylaxis and maintenance chemotherapy were administered.


RESULTS
Ages ranged from 16 to 67 (median 30). CR rate was 86.8% (46/53) and no significant prognostic factor was found for the CR rate. With a median follow-up time of 27.2 months (range 12.9-83.0 months) in living patients, the median overall survival (OS) for all cases was 16.7 months (13.4-20.1 months, 95% C.I.) and the estimated 4-year OS rate was 25.4% +/- 8.9%. The median relapse-free survival (RFS) was 12.2 months (8.4-16.0 months, 95% C.I.), and 3-year RFS rate was 29.9% +/- 10.2%. Poor prognostic factors for OS were Ph chromosome (p = 0.005) and T-cell immunophenotype (p = 0.03). For RFS they were Ph chromosome (p = 0.01) and the presence of a mediastinal mass (p = 0.03).


CONCLUSIONS
Despite an initial excellent response to the VPD (L) regimen, newer therapeutic strategies, including more intensive postremission therapies, are urgently needed because of the high relapse rate. Future therapeutic approaches need to be stratified according to several prognostic factors.
Park
Sook-Ryun
SR
Department of Internal Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, Korea. seonpark@plaza.snu.ac.kr
Kim
Jee Hyun
JH
Kim
Do Yeun
DY
Lee
Sehoon
S
Lee
Sang-Yoon
SY
Choi
In Sil
IS
Yoon
Sung-Soo
SS
Park
Seonyang
S
Kim
Byuoung-Gook
BG
Kim
Noe Kyoung
NK
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001215:Asparaginase / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015999:Multivariate Analysis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D011336:Probability; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage* / Q000009:adverse effects
D014750:Vincristine; D004317:Doxorubicin; D001215:Asparaginase; D011241:Prednisone