title: Prognostic factors in adolescent and adult patients with acute lymphoblastic leukemia with two protocols of chemotherapy: a cross-sectional study.
abstract: BACKGROUND
  We evaluated the clinical, laboratory, and prognostic factors in adolescent and adult patients with acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  In this observational, retrospective, cross-sectional study, we examined the medical records of all consecutive patients with ALL admitted to a public hospital in Brazil from 1990 to 2005.
  
  
  RESULTS
  Of the 102 patients included, 88 were treated with 2 protocols of chemotherapy (Berlin-Frankfurt-Münster [BFM] 86 modified [BFM-86M] and UCLA [University of California, Los Angeles] protocol). The complete remission (CR), disease-free survival, and overall survival (OS) rate was 70.6%, 27%, and 30.5%, respectively (median follow-up, 49 months). Age < 18 years and no leukemic infiltration in the central nervous system (CNS) at diagnosis were positively associated with CR (P = .03); no bleeding and hepatomegaly at diagnosis and age < 35 years were associated with better OS on multivariate analyses of the whole population (P = .01). OS at 4 years was superior with BFM-86M than with UCLA (49.5% vs. 16%; P = .004), especially in young adults without risk factors.
  
  
  CONCLUSIONS
  We identified age as the most important prognostic factor in patients with ALL. CNS infiltration, hepatomegaly, and bleeding were associated with lower OS but must be validated in future research with South American populations and worldwide. The BFM-86M protocol can be considered a therapeutic option for young adults (age < 35 years) without adverse prognostic factors. For other patients with ALL, we emphasize the need for different therapeutic approaches.
authors.affiliation: Universidade de Fortaleza, Hemocentro do Ceará (HEMOCE) and Hospital Monte Klinikum, Fortaleza, CE, Brasil.
authors.forename: Edilson Diogenes
authors.initials: ED
authors.lastname: Pinheiro Junior
authors.affiliation: Hospital São Camilo Pompéia, Oncology Program, Secretaria Municipal da Saúde de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Pracchia
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo and Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brasil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Beitler de Mauriño
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo and Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brasil.
authors.forename: Gracia Aparecida
authors.initials: GA
authors.lastname: Martinez
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Pedro Enrique
authors.initials: PE
authors.lastname: Dorlhiac-Llacer
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo and Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, SP, Brasil.
authors.forename: Andrezza Bertolaci
authors.initials: AB
authors.lastname: Medina
authors.affiliation: Hematology Service, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo; and Cytogenetics Laboratories, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil. Electronic address: elvira.velloso@yahoo.com.br.
authors.forename: Elvira Deolinda Rodrigues Pereira
authors.initials: ED
authors.lastname: Velloso
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000627:therapeutic use; D002648:Child; D060830:Consolidation Chemotherapy; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate
keywords: Acute leukemia; Acute lymphoblastic leukemia; Antineoplastic combined chemotherapy protocols; Drug therapy; Prognosis; Survival