title: Outcome of adult acute lymphoblastic leukemia with BFM protocol in a resource-constrained setting.
abstract: Cure rates for adult acute lymphoblastic leukemia (ALL) in developing countries are significantly lower because of problems unique to these countries. We assessed some of the problems in adult ALL patients (>12 years of age) in a tertiary care hospital of northwest India with modified BFM regimen. The diagnosis of ALL was made according to FAB criteria. The protocol consisted of Phase I & II induction, consolidation, reinduction and maintenance phases. CNS prophylaxis was administered with 24 Gy radiation and intrathecal methotrexate. One hundred and eighteen patients (72.9% males), aged 12-68 years (median 23 years) were treated from January 1997 till December 2003. Follow-up of patients was done till December 2005. Complete remission (CR) was achieved in 85.6% patients after induction therapy and 40% patient relapsed. Most patients (23.7%) relapsed during the maintenance phase or after completion of chemotherapy. At least 15% of patients (15/101) after successful induction abandoned the treatment because of financial constraints, prolonged travel time to treatment facility and switching over to alternative medicines. Fatal infectious complications occurred in 19.5% of patients. The 3-year and 5-year event free survival rates were 29.8% and 21.6% respectively. In conclusion, modified BFM regimen resulted in high induction rates but relatively poor 5-year event free survival. Infections related death and post induction abandonment of treatment were the main reasons for poor overall results.
authors.affiliation: Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India. malhotrapankaj@yahoo.com
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra
authors.forename: Subhash
authors.initials: S
authors.lastname: Varma
authors.forename: Neelam
authors.initials: N
authors.lastname: Varma
authors.forename: Savita
authors.initials: S
authors.lastname: Kumari
authors.forename: Reena
authors.initials: R
authors.lastname: Das
authors.forename: Sanjay
authors.initials: S
authors.lastname: Jain
authors.forename: Jasmina
authors.initials: J
authors.lastname: Ahluwalia
authors.forename: Sushil
authors.initials: S
authors.lastname: Mahi
authors.forename: Suresh Chander
authors.initials: SC
authors.lastname: Sharma
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Radhika
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003630:Daunorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006295:Health Resources / Q000191:economics / Q000600:supply & distribution; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D001215:Asparaginase; D011241:Prednisone; D003630:Daunorubicin