Remission Induction with Daunomycin, Vincristine, and Prednisone in Adult Acute Lymphocytic Leukemia

Oncology ◽  
1977 ◽  
Vol 34 (1) ◽  
pp. 25-28 ◽  
Author(s):  
L.H. Einhorn ◽  
W.H. Bond
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
Adult Acute Lymphocytic Leukemia

Management of adult acute lymphocytic leukemia: present issues and key challenges.

1994 ◽  
Vol 12 (6) ◽  
pp. 1312-1322 ◽  
Author(s):  
A Preti ◽  
H M Kantarjian
Keyword(s):  
T Cell ◽  
High Risk ◽  
Maintenance Therapy ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
High Risk Patients ◽  
Risk Patients ◽  
First Remission ◽  
Adult Acute Lymphocytic Leukemia

PURPOSE To discuss the controversies in current adult acute lymphocytic leukemia (ALL) management in relation to its different phases of therapy. DESIGN A review of treatments in adult ALL from the English literature. RESULTS Features signaling high risk for systemic relapse (older age, high WBC count at diagnosis, non-T-cell immunophenotype, Philadelphia chromosome (Ph)-positive karyotype, and longer time to achieve remission) are found in 60% to 70% of patients with adult ALL. These patients have a potential cure rate of 20% to 25%, compared with 60% to 70% for low-risk patients. Induction regimens with vincristine, anthracyclines, and corticosteroids appear to be optimal. Intensification-consolidation therapy increased cure rates modestly in adult ALL; higher-dose schedules of mercaptopurine (6-MP), methotrexate, and asparaginase may be beneficial. Maintenance therapy with 6-MP and methotrexate is suggested based on the worse outcome of patients in whom such maintenance was omitted. Allogeneic bone marrow transplantation (BMT) is indicated for patients in first remission with high-risk for relapse; autologous BMT for patients in first remission remains investigational. Patients with mature B-cell ALL require short-term, dose-intensive therapy that alternates hyperfractionated doses of cyclophosphamide with high-dose cytarabine (ara-C) and methotrexate. Patients with T-cell ALL may benefit from ara-C/cyclophosphamide combinations during maintenance therapy. CNS prophylaxis with intrathecal chemotherapy should be administered in patients at risk for CNS relapse. CONCLUSION Potential strategies to improve the prognosis of high-risk patients with ALL include increasing the dose-intensity of remission induction and consolidation-intensification therapies with growth factor support; discovering and using new anti-ALL drugs; improving autologous BMT results; translating biologic studies of leukemia cell characteristics, karyotype-related molecular aberrations, abnormal oncogenic expression, and minimal residual disease into clinically relevant therapies; and using investigational treatment strategies in high-risk patients.

Vincristine and prednisone vs vincristine, l-asparaginase, and prednisone for second remission induction of acute lymphocytic leukemia in children

1979 ◽  
Vol 6 (4) ◽  
pp. 317-323 ◽  
Author(s):  
Jay Herson ◽  
Kenneth A. Starling ◽  
Paul G. Dyment ◽  
G. Bennett Humphrey ◽  
Jeanette Pullen ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
Leukemia In Children

Results of Treatment With Hyper-CVAD, a Dose-Intensive Regimen, in Adult Acute Lymphocytic Leukemia

2000 ◽  
Vol 18 (3) ◽  
pp. 547-547 ◽  
Author(s):  
Hagop M. Kantarjian ◽  
Susan O’Brien ◽  
Terry L. Smith ◽  
Jorge Cortes ◽  
Francis J. Giles ◽  
...  
Keyword(s):  
B Cell ◽  
Acute Lymphocytic Leukemia ◽  
Philadelphia Chromosome ◽  
Lymphocytic Leukemia ◽  
Prognostic Models ◽  
Poor Performance Status ◽  
High Dose ◽  
Cell Disease ◽  
Adult Acute Lymphocytic Leukemia ◽  
Intensive Regimen

PURPOSE: To evaluate the efficacy and toxicity of Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone), a dose-intensive regimen, in adult acute lymphocytic leukemia (ALL). PATIENTS AND METHODS: Adults with newly diagnosed ALL referred since 1992 were entered onto the study; treatment was initiated in 204 patients between 1992 and January 1998. No exclusions were made because of older age, poor performance status, organ dysfunction, or active infection. Median age was 39.5 years; 37% were at least 50 years old. Mature B-cell disease (Burkitt type) was present in 9%, T-cell disease in 17%. Leukocytosis of more than 30 × 109/L was found in 26%, Philadelphia chromosome–positive disease in 16% (20% of patients with assessable metaphases), CNS leukemia at the time of diagnosis in 7%, and a mediastinal mass in 7%. Treatment consisted of four cycles of Hyper-CVAD alternating with four cycles of high-dose methotrexate (MTX) and cytarabine therapy, together with intrathecal CNS prophylaxis and supportive care with antibiotic prophylaxis and granulocyte colony-stimulating factor therapy. Maintenance in patients with nonmature B-cell ALL included 2 years of treatment with mercaptopurine, MTX, vincristine, and prednisone (POMP). RESULTS: Overall, 185 patients (91%) achieved complete remission (CR) and 12 (6%) died during induction therapy. Estimated 5-year survival and 5-year CR rates were 39% and 38%, respectively. The incidence of CNS relapse was low (4%). Compared with 222 patients treated with vincristine, doxorubicin, and dexamethasone (VAD) regimens, our patients had a better CR rate (91% v 75%, P < .01) and CR rate after one course (74% v 55%, P < .01) and better survival (P < .01), and a smaller percentage had more than 5% day 14 blasts (34% v 48%, P = .01). Previous prognostic models remained predictive for outcome with Hyper-CVAD therapy. CONCLUSION: Hyper-CVAD therapy is superior to our previous regimens and should be compared with established regimens in adult ALL.

scholarly journals Intensive chemotherapy with mitoxantrone and high-dose cytosine arabinoside followed by granulocyte-macrophage colony-stimulating factor in the treatment of patients with acute lymphocytic leukemia

Blood ◽  
1992 ◽  
Vol 79 (4) ◽  
pp. 876-881 ◽  
Author(s):  
HM Kantarjian ◽  
EH Estey ◽  
S O'Brien ◽  
E Anaissie ◽  
M Beran ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Complete Response ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
Intensive Chemotherapy ◽  
Colony Stimulating Factor ◽  
Gm Csf ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Stimulating Factor

Abstract Thirty-four adults with refractory acute lymphocytic leukemia received salvage therapy with mitoxantrone 5 mg/m2 intravenously over 1 hour daily for 5 days and cytosine arabinoside (ara-C) 3 g/m2 intravenously over 2 hours every 12 hours for six doses, followed by granulocyte- macrophage colony-stimulating factor (GM-CSF) 125 microgram/m2 intravenously over 4 hours daily until recovery of granulocytes above 2.0 x 10(3)/microL. Their outcome was compared with 29 prognostically similar historical control patients treated with the identical chemotherapy without GM-CSF. Overall, the complete response rates were similar in the treatment and control groups (13 of 34 [38%] v 11 of 29 [38%]). There was a trend for less remission induction mortality in the GM-CSF-treated patients (2 of 34 [6%] v 6 of 29 [21%]; P = .08), but, conversely, a higher rate of resistant disease (19 of 34 [56%] v 10 of 29 [34%]; P = .09). Recovery of granulocyte counts above 500/microL was significantly faster in the GM-CSF-treated group (25 days v 33 days; P less than .01), but there was no reduction in the incidence of febrile episodes (91% v 93%) or of documented infections (59% v 59%). Survival was prolonged in the GM-CSF-treated patients but was not of clinical relevance (31 v 20 weeks; P = .05). In summary, the addition of GM-CSF to intensive chemotherapy in refractory adult ALL was associated with a reduction in the remission induction mortality, probably secondary to a shorter duration of granulocytopenia, but not with an improvement in complete response rates.

The importance of cytogenetic studies in adult acute lymphocytic leukemia

1990 ◽  
Vol 89 (5) ◽  
pp. 579-587 ◽  
Author(s):  
Ronald Walters ◽  
Hagop M. Kantarjian ◽  
Michael J. Keating ◽  
Elihu H. Estey ◽  
Jose Trujillo ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Cytogenetic Studies ◽  
Adult Acute Lymphocytic Leukemia

scholarly journals Correction to: Serum peptidome based biomarkers searching for monitoring minimal residual disease in adult acute lymphocytic leukemia

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ju Bai ◽  
Aili He ◽  
Chen Huang ◽  
Juan Yang ◽  
Wanggang Zhang ◽  
...  
Keyword(s):  
Minimal Residual Disease ◽  
Acute Lymphocytic Leukemia ◽  
Residual Disease ◽  
Lymphocytic Leukemia ◽  
Adult Acute Lymphocytic Leukemia ◽  
Minimal Residual

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