Intensive treatment strategy for adult ALL: results of a protocol in 24 unselected patients
Majolino, I.; Fabbiano, F.; Felice, R.; Vasta, S.; Santoro, A.; Carbone, P.; Caronia, F.
Haematologica 73(3): 211-216
1988
ISSN/ISBN: 0390-6078 PMID: 3139518 Document Number: 322219
Twenty-four consecutive ALL patients over 14 years of age with an unexpectedly high rate (45%) of T-cell phenotypes were assigned to a program of intense multi-phase chemotherapy: after induction/consolidation (VCR, DNR, CTX, PDN - 6 courses, followed by L-Ase), CR patients received intensification with VM.26-Ara.C (4 doses) and maintenance (6MP-MTX plus reinductions) for up to 30 months of CR. CNS prophylaxis was performed with i.th. MTX alone and started early during induction. On the 23 evaluable patients, 21 (91.3%) attained CR and 40% of them are projected to be relapse-free for at least 57 months after CR. Median CR duration is 14 months with a median follow-up of 41 months, and 6 patients are off-therapy. Of the 11 relapses, however, 7 involved extramedullary sites (5 CNS, 1 CNS + BM + skin, 1 testis + BM) and were mostly associated with a T-cell phenotype and mediastinal mass at presentation. Intensive treatment may be highly effective in prolonging CR in adult ALL, but i.th. MTX alone seems inadequate to prevent CNS involvement in the high-risk group.