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Single centre experience with the Hyper-CVAD regimen in adult acute lymphoblastic leukemia Preliminary analysis of efficacy and toxicity

Single centre experience with the Hyper-CVAD regimen in adult acute lymphoblastic leukemia Preliminary analysis of efficacy and toxicity

Blood 98(11 Part 2): 216b, November 16

Hyper-CVAD represents an intensified program for the treatment of acute and chronic lymphoid malignancies. Although it has not been evaluated in a randomized fashion or compared with other ALL protocols it has been proposed as a highly efficient treatment for adult ALL, with acceptable toxicity profile (Kantarjian H.M. et al. JCO; 18:3, 2000). Purpose: In our institution, Hyper-CVAD was initiated in September 99 and used in the treatment of 14 consecutive adults with ALL. We analyze and report here our preliminary results focusing on the efficacy and the toxicity of the program. Patient and Methods: Patient population consisted of 10 de novo ALL (6 T-cell, 4 B-cell), group A, 2 blastic-phase CML (B-cell) and 2 relapsed ALL (B-cell), group B. M/F ratio was 10/4, median age 42.5 yrs, mean age 44 yrs (range 18-68 yrs). 6/14 (43%) patients were older than 50 yrs. Hyperleucocytosis of >100X109/L was present in 4/14 (28%) cases (3 T-cell, 1 B-cell) while splenomegaly, lymphadenopathy and bulky mediastinum were documented in 71%, 64% and 7% of cases respectively. Chromosome analysis was available in 12/14 patients, in 5 was normal, in 1 showed del(12), in 2 CML cases a typical t(9;22) and in 4 metaphases were insufficient. None of the cases presented with CNS disease (morphology+immunophenotyping) neither any non-CML case carried the bcr-abl translocation. Results: Median follow up was 6.5 months (range 18d-17mon). Hematological complete remission was achieved in 7/10 (70%) de novo ALL cases (group A) and in 1/4 (25%) relapsed ALL/blastic-CML cases (group B). Resistant disease was documented in 3/14 (21.4%) cases, which subsequently received other therapeutic protocols. Disease progression following initial response was seen in another 3 cases, 3 out of 5 (60%) evaluable T-ALL cases relapsed, 2 during the consolidation phase, 1 during maintenance. CNS involvement whilst on hyper-CVAD was not detected in the subgroup of resistant/progressive patients. Toxic deaths occurred in 3/14 (21.4%) cases, 2 of them in remission status. One death occurred in early induction and 2 in consolidation. Conclusions: Within the limitations of the small patient number and relatively short follow up we confirm the effectiveness of hyper-CVAD in de novo ALL, albeit at a lower than expected magnitude, in accordance with other reports (Lozada J.A. et al. Blood:96; 11 Abstr 4645). In contrast, results in secondary/relapsed ALL are poor. Furthermore, we are unable to confirm the reported excellent outcome in T-ALL. Toxicity, especially infectious complications, was significant despite the administration of growth factors and prophylactic antibiotics. The regimen can prevent leukemia extention to CNS in both responders and progressors. Different patient and ethnic characteristics may account for the disparate results presented in this study compared to the initial report.

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Accession: 035734180

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