Outcome of adults with acute lymphocytic leukemia after second salvage therapy.
BACKGROUND
The outcome of adults with acute lymphocytic leukemia (ALL) who undergo second salvage therapy has been characterized poorly. This is important with regard to investigational approaches aimed at helping this subset of patients. The objectives of the current study were to predict outcomes and determine the prognostic factors associated with second salvage therapy in patients with ALL.


METHODS
In this study, 288 patients were analyzed who received second salvage therapy for ALL at the authors' institution.


RESULTS
Overall, 53 patients (18%) achieved a complete response (CR). The median remission duration was 7 months and the median survival was 3 months. In multivariate analysis, prognostic factors that were associated independently with achieving CR were duration of first CR and platelet count. Patients with a first CR <36 months and platelet counts <50 x 10(9)/L had an expected CR rate of 7%. In multivariate analysis, prognostic factors that were associated independently with survival were duration of first CR, percentage bone marrow blasts, platelet count, and albumin level. The expected 12-month survival rates for patients with 0 or 1, 2, 3, or 4 adverse factors were 33%, 14%, 8%, and 0%, respectively. A repeat multivariate analysis using landmark assessment at 6 weeks selected achievement of CR as adding significantly to the survival benefit (P = .0001; hazard ratio, 0.51). Only 22 patients (8%) were able to undergo allogeneic stem cell transplantation as second salvage therapy, and their 1-year survival rate was 18%.


CONCLUSIONS
The outcome of adults with ALL undergoing second salvage therapy is poor. Novel effective therapies against ALL are needed in this subset of patients.
O'Brien
Susan
S
Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Thomas
Deborah
D
Ravandi
Farhad
F
Faderl
Stefan
S
Cortes
Jorge
J
Borthakur
Gautum
G
Pierce
Sherry
S
Garcia-Manero
Guillermo
G
Kantarjian
Hagop M
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D016896:Treatment Outcome