title: Feasibility and outcome of the hyper-CVAD regimen in patients with adult acute lymphoblastic leukemia.
abstract: BACKGROUND
  Current chemotherapy regimens for adults with acute lymphoblastic leukemia (ALL) result in high rates of complete remission (CR), but relapses are still frequent.
  
  
  METHODS
  In this retrospective single-center study, we evaluated the results of the Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) regimen in 49 ALL patients treated between 2001 and 2013. No exclusion criteria were applied. The primary outcome measure was the CR rate.
  
  
  RESULTS
  Forty-six of the 49 patients (93.8%) obtained CR, and 3 (6%) patients died during induction. Philadelphia chromosome was present in 6 patients (12.2%); in all a CR was obtained. Among the 46 patients in CR, 30 (65.2%) received the full planned intensive-phase treatment (8 cycles). Allogeneic hematopoietic cell transplantation was performed in 2 (4%) patients in first CR and in 3 (6%) patients after a second CR. Nonrelapse mortality was observed in 8 patients (16.3%). The median overall survival (OS) and 5-year OS were 24.4 months and 35%, respectively. Initial leukocyte count (> 30 × 10(9)/L) was an important prognostic factor.
  
  
  CONCLUSIONS
  Hyper-CVAD as an induction regimen for adults and adolescents with ALL was feasible and yielded a high rate of CR. Relapse rates and OS were comparable to other series but still unsatisfactory.
authors.affiliation: Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janiero, Brazil. Electronic address: doyle66@gmail.com.
authors.forename: Rodrigo Doyle
authors.initials: RD
authors.lastname: Portugal
authors.affiliation: Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janiero, Brazil.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Loureiro
authors.affiliation: Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janiero, Brazil.
authors.forename: Márcia
authors.initials: M
authors.lastname: Garnica
authors.affiliation: Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janiero, Brazil.
authors.forename: Wolmar
authors.initials: W
authors.lastname: Pulcheri
authors.affiliation: Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janiero, Brazil.
authors.forename: Márcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007621:Karyotyping; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide
keywords: ALL; Philadelphia; Remission; Survival; Transplantation