Effect of Treatment with Intensified Induction Regimen in Adult Acute Lymphocytic Leukemia / 대한혈액학회지

ABSTRACT

BACKGROUND: Adult acute lymphocytic leukemia (ALL) is a hematologic malignant disease characterized by an uncontrolled proliferation of immature lymphocytes and their progenitors. Progress in the treatment of adults with ALL has been more difficult to achieve, and until recently there was general agreement that adults have lower remission rates, briefer duration of remissions, and shorter survival times than that of children receiving identical treatment. METHODS: Twenty one patients with ALL were treated with remission induction chemotherapy consisting of vincristine, prednisolone, daunorubicin and L-asparaginase. After successful remission induction, consolidation-intensification and maintenance therapy, CNS prophylaxis were done. RESULTS: 1) The overall complete remission (CR) rate was 66.7% (14/21). The median remission duration for the 14 patients with CR was 16 months (3~31 months) and the median overall survival time was 11 months (1~35 months). The 3-year relapse free survival rate was 14.3% and the median time to complete remission was 41 days (18~71 days). The median overall survival time of complete remission group was 31.8 months and non-response group was 1.4 months. 2) Five (23.8%) patients died during the induction therapy period and two patients did not respond to treatment. 3) Six out of fourteen patients (42.9%) who had achieved remission relapsed and the sites of relapse were the bone marrow (66.7%) and CNS (16.7%). 4) Fourteen patients (66.7%, 14/21) died during follow-up period. The main causes of death were infection in eight cases (57.1%) and hemorrhage in two (14.3%). 5) Favorable factors influencing the remission rate were initial response to chemotherapy and sex (P=0.031), and factor influencing survival time was complete remission (P=0.005). CONCLUSION: This induction regimen was thought to be effective in remission rate, but it has considerable number of side effects and the shortness of the remission duration. In the future, more intensified induction and consolidation chemotherapy should be considered.