title: Escalated daunorubicin dosing as an induction treatment for Philadelphia-negative adult acute lymphoblastic leukemia.
abstract: The dose intensity of daunorubicin (DNR) delivered during the induction period represented the major prognostic factor for the outcome of adult acute lymphoblastic leukemia (ALL). The aim of this study was to determine the survival or toxicity of escalated doses of DNR in induction treatment of adult patients with acute lymphoblastic leukemia who are at least 15 years of age. For induction chemotherapy, all patients were given 90 mg/m(2)/day of DNR by continuous intravenous (IV) infusion over 24 h daily on days 1-3, 2 mg of vincristine IV push on days 1 and 8, and 60 mg/m(2)/day of prednisolone per oral (PO) on days 1-14 in conjunction with 4,000 units/m(2)/day of L-asparaginase intramuscular or subcutaneous on days 17-28. The median patient age was 32 years (range, 15-69). Complete remission (CR) was achieved in 169 (88.5 %) patients, while 4 died before CR was reached. Additionally, 11 patients died from leukemia progression, 4 had refractory disease, and 3 had follow-up loss. The median follow-up time was 697 days (range, 12-2,270). The 3-year cumulative incidence of relapse was 49.3 %. The probabilities of disease-free survival and overall survival at 3 years were 46.1 and 43.1 %, respectively. The dose of DNR was 100 % of the target dose, and there were no additional specific toxicities. The results show that escalated doses of DNR in induction chemotherapy are similar with the standard dose in response and toxicities. Our study indicates that a more effective regimen or better chemotherapy agents are needed to improve the CR rate and prolong survival in Philadelphia-negative adult ALL.
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Gaegumdong, Busanjingu, Busan, Republic of Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Eom
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Won
authors.forename: Kyoo-Hyung
authors.initials: KH
authors.lastname: Lee
authors.forename: Je-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Dae-Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Chul Won
authors.initials: CW
authors.lastname: Jung
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Hun-Mo
authors.initials: HM
authors.lastname: Ryoo
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: Sung-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Yeung-Chul
authors.initials: YC
authors.lastname: Mun
authors.forename: Min Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Young Don
authors.initials: YD
authors.lastname: Joo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D002490:Central Nervous System / Q000473:pathology; D060830:Consolidation Chemotherapy; D016371:Cranial Irradiation; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D054438:Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / Q000188:drug therapy*; D017254:Leukemic Infiltration / Q000517:prevention & control; D060046:Maintenance Chemotherapy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014750:Vincristine; D011239:Prednisolone; D001215:Asparaginase; D003630:Daunorubicin