Outcome after first relapse in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukaemia.
To analyse the outcome of adult patients who developed a first relapse of acute lymphoblastic leukaemia (ALL), we collected the clinical data of 332 patients with Philadelphia-chromosome (Ph) negative ALL, aged 16-65 years, who relapsed after first complete remission (CR1) between 1998 and 2008 in 69 institutions all over Japan, including 58 patients who relapsed after allogeneic haematopoietic stem cell transplantation (Allo-HSCT) in CR1. The overall survival (OS) was 43·4% at 1 year, and 16·3% at 5 years from relapse in patients who received chemotherapy alone in CR1. Among patients who relapsed after chemotherapy alone in CR1, 123 (52·5%) achieved a second remission (CR2) following salvage chemotherapy, of whom 62 subsequently underwent Allo-HSCT during CR2. Allo-HSCT in CR2 was significantly associated with better OS. Moreover, the type of salvage chemotherapy influenced OS from relapse. A doxorubicin, vincristine, and predonisone-based (AdVP-type) regimen was related to better OS in patients with longer CR1 (more than 1 year), but was related to worse OS in patients with shorter CR1. In conclusion, the prognosis of patients with relapsed Ph-negative ALL is poor. Allo-HSCT after a first relapse could improve the prognosis. Selection of the optimal salvage chemotherapy might depend on the duration of CR1.
Division of Haematology, Saitama Medical Centre, Jichi Medical University, Saitama, Japan.
Shinichi
S
Kako
Heiwa
H
Kanamori
Naoki
N
Kobayashi
Akio
A
Shigematsu
Yasuhito
Y
Nannya
Mika
M
Nakamae
Kazuyuki
K
Shigeno
Kazumi
K
Suzukawa
Masahiro
M
Takeuchi
Motohiro
M
Tsuzuki
Kensuke
K
Usuki
Kazuo
K
Hatanaka
Kazuei
K
Ogawa
Kinuko
K
Mitani
Yuichiro
Y
Nawa
Yoshihiro
Y
Hatta
Ishikazu
I
Mizuno
Yoshinobu
Y
Kanda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult