title: High curability via intensive reinduction chemotherapy and stem cell transplantation in young adults with relapsed acute lymphoblastic leukemia in Sweden 2003-2007.
abstract: BACKGROUND
  A minority of patients with adult acute lymphoblastic leukemia who relapse are rescued. The aim of this population-based study was to assess the results of reinduction treatment and allogeneic stem cell transplantation in patients in second complete remission.
  
  
  METHODS
  Between 2003-2007, 76 adults (<66 years) with relapsed acute lymphoblastic leukemia (Burkitt's leukemia excluded) were prospectively reported to The Swedish Adult Acute Leukemia Registry and later evaluated.
  
  
  RESULTS
  Reinduction with: (i) mitoxantrone, etoposide, and cytarabine (MEA); (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor (FLAG-Asp); and (iii) cytarabine, betamethasone, cyclophosphamide, daunorubicin, and vincristine (ABCDV) resulted in complete remission in 6/9 (67%), 10/16 (63%) and 9/21 (43%) of the patients, respectively. Allogeneic stem cell transplantation was performed during second complete remission in 29 patients. Multivariate analysis regarding overall survival after relapse revealed that age over 35 years at diagnosis and relapse within 18 months were negative prognostic factors. Overall survival rates at 3 and 5 years were 22% (95% CI: 13-32) and 15% (95% CI: 7-24). Of 19 patients less than 35 years at diagnosis who underwent allogeneic stem cell transplantation in second remission, ten (53%) are still alive at a median of 5.5 years (range, 4.2-8.3) after relapse, whereas all patients over 35 years old at diagnosis have died.
  
  
  CONCLUSIONS
  Allogeneic stem cell transplantation remains the treatment of choice for young adults with relapsed acute lymphoblastic leukemia. Both (i) mitoxantrone, etoposide, and cytarabine and (ii) fludarabine, cytarabine, pegylated-asparaginase plus granulocyte colony-stimulating factor seem effective as reinduction treatments and should be further evaluated. New salvage strategies are needed, especially for patients over 35 years old at diagnosis.
authors.affiliation: Department of Medicine, Örebro University Hospital 01 85 Örebro, Sweden. piotr.kozlowski@orebroll.se
authors.forename: Piotr
authors.initials: P
authors.lastname: Kozlowski
authors.forename: Maria
authors.initials: M
authors.lastname: Åström
authors.forename: Lucia
authors.initials: L
authors.lastname: Ahlberg
authors.forename: Per
authors.initials: P
authors.lastname: Bernell
authors.forename: Erik
authors.initials: E
authors.lastname: Hulegårdh
authors.forename: Hans
authors.initials: H
authors.lastname: Hägglund
authors.forename: Karin
authors.initials: K
authors.lastname: Karlsson
authors.forename: Alicja
authors.initials: A
authors.lastname: Markuszewska-Kuczymska
authors.forename: Beata
authors.initials: B
authors.lastname: Tomaszewska-Toporska
authors.forename: Bengt
authors.initials: B
authors.lastname: Smedmyr
authors.forename: Helene
authors.initials: H
authors.lastname: Hallböök
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D013548:Sweden; D013997:Time Factors; D055815:Young Adult