Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group.
BACKGROUND
About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia.


METHODS
We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials.


RESULTS
The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%).


CONCLUSIONS
The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.
Oriol
Albert
A
Servei d'Hematologia Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain. aoriol@iconcologia.net
Vives
Susana
S
Hernández-Rivas
Jesús-María
JM
Tormo
Mar
M
Heras
Inmaculada
I
Rivas
Concepción
C
Bethencourt
Concepción
C
Moscardó
Federico
F
Bueno
Javier
J
Grande
Carlos
C
del Potro
Eloy
E
Guardia
Ramon
R
Brunet
Salut
S
Bergua
Juan
J
Bernal
Teresa
T
Moreno
Maria-José
MJ
Calvo
Carlota
C
Bastida
Pilar
P
Feliu
Evarist
E
Ribera
Josep-Maria
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents