Treatment of acute lymphoblastic leukemia in adults between january 2007 to december 2011 at the department of haematology in Ljubljana
Abstract
Background: The prognosis of acute lymphoblastic leukemia (ALL) in adults is far worse than in children. The results of several collaborative trials for the treatment of ALL indicate that complete remission can now be achieved in 90 % of patient under the age of 60, but most patients relapse.
Patients and methods: Between January 2007 and December 2011, 27 adults patients with newly diagnosed ALL were treated at the Department of Haematology in Ljubljana (22 patients had B-ALL, 5 patients T-ALL). The median age spreof the patients was 48 years, range 21–77 years. Cytogenetic investigations of the bone marrow were performed in 26 patients, 8 patients had t(9;22). 19 patients were eligible for induction chemotherapy according to UKALL XII regimen (the median age 44 years), 3 patients for induction chemotherapy with children ALL regimen and 5 older patients received VAD regimen. We conducted 9 allogenic stem-cell transplantations (SCT), including 2 related donor SCT and 7 unrelated donor SCT, no autologous SCT was done.
Results: 17 patients (88 %) achieved complete remission with UKALL XII regimen; 6 of these patients died within 6 weeks after start of chemotherapy. Predominant causes of death were infections and respiratory failure. Three younger patients achived complete remission with children ALL regimen, 1 relapsed. Three patients died after allogenic SCT in remission because of chronic GVHD and infection-related complications of immunosupresion treatment, 1 patient died because of respiratory failure in remission.
Conclusions: The UKALL XII regimen and children ALL regimen represent an aggressive approach, including high-dose corticosteroids. We conclude that cytogenetics is a strong independent prognostic factor. In most patients we can achieve a complete remission, but most patient relapse .We had more deaths in remission induction treatment with UKALL XII regimen. Allogenic SCT or prolonged consolidation and maintenance treatment is warranted. In patients over 70 years of age we do not use intensive chemotherapy.
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