Journal Article

Induction therapy by frequent administration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acute lymphoblastic leukemia: the JALSG-ALL93 study

Miyawaki, S, Ohno, R, Takeuchi, J, Okamoto, T, Ino, T, Mizuta, S, Asou, N, Kyo, T, Fukushima, T, Ohshima, T, Kuriyama, K, Takahashi, M, Yagasaki, F, Nakamura, Y, Shinagawa, K, Usui, N, Taguchi, H, Akiyama, H, Naito, K, Ohtake, S, Murakami, H, Nishimura, M, Morii, T, Sao, H

2002

Overview

In order to improve the disappointing prognosis of adult patients with acute lymphoblastic leukemia (ALL), we applied similar induction therapy as that used for acute myeloid leukemia (AML), ie frequent administration of doxorubicin (DOX). DOX 30 mg/m(2) was administered from days 1 to 3 and from days 8 to 10 together with vincristine, prednisolone, cyclophosphamide and L-asparaginase, followed by three courses of consolidation and four courses of intensification. From December 1993 to February 1997, 285 untreated adult patients with de novo ALL were entered. Of 263 evaluable patients (age 15 to 59; median 31), 205 (78%) obtained complete remission (CR). At a median follow-up period of 63 months, the predicted 6-year overall survival (OS) rate of all patients was 33%, and disease-free survival (DFS) rate of CR patients was 30%, respectively. By multivariate analysis, favorable prognostic factors for the achievement of CR were age <40 and WBC <50 000/microl; for longer OS were age <30 and WBC <30 000/microl; and for longer DFS of CR patients were FAB L1 and ALT <50 IU/l. Among 229 patients who had adequate cytogenetic data, 51 (22%) had Philadelphia (Ph) chromosome. Ph-negative chromosome was a common favorable prognostic factor for CR, longer OS and DFS. DFS was not different between early sequential intensification (n = 48) and intermittent intensification (n = 43) during the maintenance phase. Among CR patients under 40 years old, the 6-year survival was not different between the allocated related allo-BMT group (34 patients) and the allocated chemotherapy group (108 patients). However, among patients with Ph-positive ALL, the survival of patients who actually received allo-BMT was superior to that of patients who received chemotherapy (P = 0.046).

• Publisher: Nature Publishing,Nature Publishing Group
• Subject: Acute lymphoblastic leukemia / Acute myeloid leukemia / Age / Antibiotics, Antineoplastic - administration & dosage / Antineoplastic agents / Antineoplastic Combined Chemotherapy Protocols - administration & dosage / Asparaginase / Asparaginase - administration & dosage / Biological and medical sciences / Bone Marrow Transplantation / Chemotherapy / Chromosomes / Combined Modality Therapy / Combined treatments (chemotherapy of immunotherapy associated with an other treatment) / Consolidation / Cyclophosphamide / Cyclophosphamide - administration & dosage / Cytogenetics / Doxorubicin / Doxorubicin - administration & dosage / Humans / Induction therapy / L-asparaginase / Leukemia / Lymphatic leukemia / Maintenance / Medical prognosis / Medical sciences / Multivariate analysis / Pharmacology. Drug treatments / Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology / Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy / Prednisolone / Prednisolone - administration & dosage / Prognosis / Remission / Remission Induction / Stem cell transplantation / Survival / Survival Analysis / Transplantation, Homologous / Vincristine / Vincristine - administration & dosage