title: Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993.
abstract: The international acute lymphoblastic leukemia (ALL) study was designed to prospectively define the optimal therapy for adults 60 years of age or younger with newly diagnosed ALL. All patients received identical induction therapy, and 91% achieved complete remission (CR). Patients 50 years of age or younger with a compatible sibling were assigned to undergo allogeneic transplantation; the others were randomly assigned to autologous transplantation or to consolidation/maintenance therapy for 2.5 years. Patients who did not achieve CR after induction had an overall survival rate of 5% compared with 45% for patients who achieved CR. Factors at diagnosis predictive of overall survival and disease-free survival were age (P = .001), white blood cell count less than 30 x 10(9)/L for B lineage or less than 100 x 10(9)/L for T lineage (P = .001) and immunophenotype, T lineage versus B lineage (P = .001). The data demonstrate that achieving CR with induction therapy is indispensable for long-term survival in adult patients with ALL. Furthermore, with a response rate greater than 90%, the induction regimen was highly efficacious as remission-inducing therapy. This large database has validated several previously identified independent prognostic factors in ALL, such as age, white blood cell count at presentation, cytogenetics, and immunophenotype. However, the achievement of CR within 4 weeks does not appear to be an independent prognostic factor.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center and Technion, Israel Institute of Technology, Haifa 31096, Israel. rowe@jimmy.harvard.edu
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.forename: Georgina
authors.initials: G
authors.lastname: Buck
authors.forename: Alan K
authors.initials: AK
authors.lastname: Burnett
authors.forename: Raj
authors.initials: R
authors.lastname: Chopra
authors.forename: Peter H
authors.initials: PH
authors.lastname: Wiernik
authors.forename: Susan M
authors.initials: SM
authors.lastname: Richards
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Ian M
authors.initials: IM
authors.lastname: Franklin
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Niculae
authors.initials: N
authors.lastname: Ciobanu
authors.forename: H Grant
authors.initials: HG
authors.lastname: Prentice
authors.forename: Jill
authors.initials: J
authors.lastname: Durrant
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Goldstone
mesh_terms: D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome