Intensified consolidation therapy with dose-escalated doxorubicin did not improve the prognosis of adults with acute lymphoblastic leukemia: the JALSG-ALL97 study.
We designed a treatment protocol for newly diagnosed adult acute lymphoblastic leukemia (ALL) in the pre-imatinib era, employing intensified consolidation therapy with a total of 330 mg/m² doxorubicin and adopting slightly modified induction and maintenance regimen of the CALGB 8811 study. Of 404 eligible patients (median age 38 years, range 15-64 years), 298 (74%) achieved complete remission (CR). The 5-year overall survival (OS) rate was 32%, and the 5-year disease-free survival (DFS) rate was 33%. Of 256 Philadelphia chromosome (Ph)-negative patients, 208 (81%) achieved CR and the 5-year OS rate was 39%, and 60 of them underwent allogeneic-hematopoietic stem cell transplantation (allo-HSCT) from related or unrelated donors during the first CR, resulting in 63% 5-year OS. Of 116 Ph-positive patients, 65 (56%) achieved CR and the 5-year OS rate was 15%, and 22 of them underwent allo-HSCT from related or unrelated donors during the first CR, resulting in 47% 5-year OS. In Ph-negative patients, multivariate analysis showed that older age, advanced performance status and unfavorable karyotypes were significant poor prognostic factors for OS and higher WBC counts for DFS. The present treatment regimen could not show a better outcome than that of our previous JALSG-ALL93 study for adult ALL.
Jinnai
Itsuro
I
Department of Health Evaluation, Ogawa Red Cross Hospital, Hiki-gun, Saitama, 355-0397, Japan. jinjin@ogawa.jrc.or.jp
Sakura
Tohru
T
Tsuzuki
Motohiro
M
Maeda
Yasuhiro
Y
Usui
Noriko
N
Kato
Masayuki
M
Okumura
Hirokazu
H
Kyo
Taiichi
T
Ueda
Yasunori
Y
Kishimoto
Yuji
Y
Yagasaki
Fumiharu
F
Tsuboi
Kosuke
K
Horiike
Shigeo
S
Takeuchi
Jin
J
Iwanaga
Masako
M
Miyazaki
Yasushi
Y
Miyawaki
Shuichi
S
Ohnishi
Kazunori
K
Naoe
Tomoki
T
Ohno
Ryuzo
R
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000627:therapeutic use*; D004317:Doxorubicin / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D011379:Prognosis; D012074:Remission Induction; D016019:Survival Analysis; D055815:Young Adult
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin