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A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811.

Publication ,  Journal Article
Larson, RA; Dodge, RK; Burns, CP; Lee, EJ; Stone, RM; Schulman, P; Duggan, D; Davey, FR; Sobol, RE; Frankel, SR
Published in: Blood
April 15, 1995

The goal of this phase II multicenter clinical trial was to evaluate a new intensive chemotherapy program for adults with untreated acute lymphoblastic leukemia (ALL) and to examine prospectively the impact of clinical and biologic characteristics on the outcome. One hundred ninety-seven eligible and evaluable patients (16 to 80 years of age; median, 32 years of age) received cyclophosphamide, daunorubicin, vincristine, prednisone, and L-asparaginase; 167 patients (85%) achieved a complete remission (CR), 13 (7%) had refractory disease, and 17 (9%) died during induction. A higher CR rate was observed in younger patients (94% for those < 30 years old, 85% for those 30 to 59 years old, and 39% for those > or = 60 years old, P < .001) and in those who had a mediastinal mass (100%) or blasts with a T-cell immunophenotype. Eighty percent of B-lineage and 97% of T-cell ALL patients achieved a CR (P = .01). The coexpression of myeloid antigens did not affect the response rate or duration. Seventy percent of those with cytogenetic or molecular evidence of the Philadelphia (Ph) chromosome and 84% of those without such evidence achieved a CR (P = .11). Patients in remission received multiagent consolidation treatment, central nervous system prophylaxis, late intensification, and maintenance chemotherapy for a total of 24 months. After a median follow-up time of 43 months, the median survival for all 197 patients is 36 months; the median remission duration for the 167 CR patients is 29 months. Favorable pretreatment characteristics relative to remission duration or survival are younger age, the presence of a mediastinal mass or lymphadenopathy, a white blood cell count (WBC) less than 30,000/microL, L1 morphology, T or TMy immunophenotype, and the absence of the Ph chromosome. The estimates of the proportion surviving at 3 years are 69% for patients less than 30 years old, 39% for those 30 to 59 years old, 89% for those who had a mediastinal mass, 59% with WBC less than 30,000/microL, 63% with L1 morphology, 69% for T or TMy antigen expression, and 62% for those who lack the Ph chromosome. Fifteen patients (8%) had no unfavorable prognostic factors and have an estimated probability of survival at 5 years of 100% (95% confidence interval, 77% to 100%). This intensive chemotherapy regimen produces a high remission rate and a high proportion of durable remissions in adults with ALL.

Duke Scholars

Published In

Blood

ISSN

0006-4971

Publication Date

April 15, 1995

Volume

85

Issue

8

Start / End Page

2025 / 2037

Location

United States

Related Subject Headings

  • Vincristine
  • Treatment Outcome
  • Thioguanine
  • Survival Analysis
  • Risk Factors
  • Remission Induction
  • Prospective Studies
  • Prednisone
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Multivariate Analysis
 

Citation

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Larson, R. A., Dodge, R. K., Burns, C. P., Lee, E. J., Stone, R. M., Schulman, P., … Frankel, S. R. (1995). A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood, 85(8), 2025–2037.
Larson, R. A., R. K. Dodge, C. P. Burns, E. J. Lee, R. M. Stone, P. Schulman, D. Duggan, F. R. Davey, R. E. Sobol, and S. R. Frankel. “A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811.Blood 85, no. 8 (April 15, 1995): 2025–37.
Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995 Apr 15;85(8):2025–37.
Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, Duggan D, Davey FR, Sobol RE, Frankel SR. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811. Blood. 1995 Apr 15;85(8):2025–2037.

Published In

Blood

ISSN

0006-4971

Publication Date

April 15, 1995

Volume

85

Issue

8

Start / End Page

2025 / 2037

Location

United States

Related Subject Headings

  • Vincristine
  • Treatment Outcome
  • Thioguanine
  • Survival Analysis
  • Risk Factors
  • Remission Induction
  • Prospective Studies
  • Prednisone
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Multivariate Analysis