title: [Acute Ph-negative lymphoblastic leukemias in adults: Risk factors in the use of the ALL-2009 protocol].
abstract: OBJECTIVE
  to analyze well-known risk factors (RFs), such as age, immunophenotype, baseline leukocytosis, enhanced lactate dehydrogenase (LDH) activity, time to achieve complete remission, a risk group, and cytogenetic abnormalities) in patients with acute lymphoblastic leukemia (ALL) in the use of the ALL-2009 protocol.
  
  
  METHODS
  The protocol covered 298 patients (137 women (including 13 pregnant women) and 161 men) aged 15 to 55 years (median age 28 years) with Ph-negative ALL. The phenotype was unknown in 6 patients. Three (1%) were ascertained to have a biphenotypic variant. 182 (62.4%) patients were found to have B-cell ALL (early pre-B ALL (n=51); common ALL (n=92), and pre-B ALL (n=39); 107 (36.6%) patients had T-cell ALL (early T-ALL (n=56); thymic T-ALL (n=41), and mature T-ALL (n=10). According to the baseline clinical and laboratory parameters (leukocytosis of 30·109/l and more for B-ALL; and that of 100·109/l and more for T-ALL; phenotype В-I for B-ALL, phenotype Т-I-II-IV for T-ALL; LDH activity was more than twice the normal values; the presence of translocation t(4;11)), the high-risk group included most patients with B-ALL (n=110 (72.8%)) and T-ALL (n=76 (76%)). Thirty-five patients with T-ALL underwent autologous bone marrow transplantation (BMT). Allogeneic BMT was performed in 18 (7%) of the 258 patients who had undergone an induction phase.
  
  
  RESULTS
  Five-year overall survival for all the patients included in the investigation was 59%; relapse-free survival was 65%, which was significantly different in the patients with B-ALL and in those with T-ALL: the overall survival rates were 53.3 and 67.5% (p=0.1); the relapse-free survival was 56 and 79% (p=0.005), respectively. Multivariate analysis including the well-known RFs demonstrated that the latter for T-ALL were of no independent prognostic value and only the patient's age was identified for B-ALL (p=0.013).
  
  
  CONCLUSIONS
  A lower chemotherapeutic load and a small number of allogeneic BMTs did not affect total positive treatment results in adult patients with ALL, by complying with the principle achieving the continuity of cytostatic effects and by preserving the total cytostatic loading dose. The results of the Russian investigation casts some doubt on the necessity of using very intensive consolidation cycles and performing a large number of allogeneic BMTs in adult patients with ALL.
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E N
authors.initials: EN
authors.lastname: Parovichnikova
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A N
authors.initials: AN
authors.lastname: Sokolov
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V V
authors.initials: VV
authors.lastname: Troitskaya
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G A
authors.initials: GA
authors.lastname: Klyasova
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: M A
authors.initials: MA
authors.lastname: Rusinov
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: Z Kh
authors.initials: ZK
authors.lastname: Akhmerzaeva
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: L A
authors.initials: LA
authors.lastname: Kuzmina
authors.affiliation: Research Institute of Pediatric Hematology and Transplantology, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia.
authors.forename: S N
authors.initials: SN
authors.lastname: Bondarenko
authors.affiliation: N.N. Blokhin Russian Cancer Research Center, Moscow, Russia.
authors.forename: O Yu
authors.initials: OY
authors.lastname: Baranova
authors.affiliation: Order of the Badge of Honor Irkutsk Regional Clinical Hospital, Irkutsk, Russia.
authors.forename: T S
authors.initials: TS
authors.lastname: Kaporskaya
authors.affiliation: Kirov Research Institute of Hematology and Blood Transfusion, Federal Biomedical Agency of Russia, Kirov, Russia.
authors.forename: E N
authors.initials: EN
authors.lastname: Zotina
authors.affiliation: Surgut District Clinical Hospital, Surgut, Russia.
authors.forename: E E
authors.initials: EE
authors.lastname: Zinina
authors.affiliation: N.A. Semashko Nizhny Novgorod Regional Clinical Hospital, Nizhny Novgorod, Russia.
authors.forename: O S
authors.initials: OS
authors.lastname: Samoilova
authors.affiliation: Mordovian Republican Clinical Hospital, Saransk, Russia.
authors.forename: L V
authors.initials: LV
authors.lastname: Gavrilova
authors.affiliation: Volgograd Regional Clinical Oncology Dispensary One, Volgograd, Russia.
authors.forename: K D
authors.initials: KD
authors.lastname: Kaplanov
authors.affiliation: Regional Clinical Hospital One, Yekaterinburg, Russia.
authors.forename: T S
authors.initials: TS
authors.lastname: Konstantinova
authors.affiliation: Regional Clinical Hospital, Yaroslavl, Russia.
authors.forename: V A
authors.initials: VA
authors.lastname: Lapin
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S K
authors.initials: SK
authors.lastname: Kravchenko
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E O
authors.initials: EO
authors.lastname: Gribanova
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E E
authors.initials: EE
authors.lastname: Zvonkov
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: O A
authors.initials: OA
authors.lastname: Gavrilina
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G A
authors.initials: GA
authors.lastname: Baskhaeva
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G M
authors.initials: GM
authors.lastname: Galstyan
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: T N
authors.initials: TN
authors.lastname: Obukhova
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: I V
authors.initials: IV
authors.lastname: Galtseva
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S M
authors.initials: SM
authors.lastname: Kulikov
authors.affiliation: National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V G
authors.initials: VG
authors.lastname: Savchenko
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002985:Clinical Protocols; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000145:classification / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D012307:Risk Factors; D014182:Transplantation, Autologous; D055815:Young Adult