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Reinforced HEAV'D therapy for adult acute lymphoblastic leukemia: Improved results and revised prognostic criteria
Author(s) -
Bassan Renato,
Battista Raffaele,
Montaldi Anna,
Rambaldi Alessandro,
D'emilio Anna,
Viero Piera,
Borleri Gianmaria,
Buelli Maurizio,
Dini Enrico,
Barbui Tiziano
Publication year - 1993
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2900110402
Subject(s) - lymphoblastic leukemia , medicine , oncology , intensive care medicine , leukemia
Thirty‐six adults with acute lymphoblastic leukemia (ALL) were treated with adriamycin, vincristine. prednisolone, and asparaginase for remission induction, followed by vincristine‐adriamycin‐cyclophosphamide consolidation courses, cranial irradiation, a short ara‐C plus VM‐26 pulse, and vincristine plus cyclophosphamide rotating weekly with ara‐C plus VM‐26 for three months (reinforced HEAV'D). Thirty‐one patients achieved a complete remission (86 per cent). Compared with historical results from a prior study, age >30 years, absolute blast count >15 × 10 9 /1, and CD10‐negative immunophenotype were not associated with higher relapse rate and shorter survival, suggesting a positive effect from intensification therapy with ara‐C and VM‐26 in these poor prognostic categories. However, patients with an abnormal karyotypic pattern or a positive molecular study for BCR‐ABL rearrangement detecting t(9;22) had a far greater likelihood of treatment failure (probability of remission at 3 years 0·10) than those with normal karyotype or negative molecular study (probability 0·70), and those not studied or with insufficient methaphases (probability 0·50) ( p <0·05 by log‐rank test). These results underline the prognostic importance of chromosomal abnormalities and the usefulness of ara‐C and VM‐26 in the management of adult ALL.