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Treatment of Adult Acute Lymphoblastic Leukemia with the Hyper-CVAD Regimen Preliminary Analysis from a Single Center

Treatment of Adult Acute Lymphoblastic Leukemia with the Hyper-CVAD Regimen Preliminary Analysis from a Single Center

Blood 100(11): Abstract No 4617, November 16

Hyper-CVAD represents an intensified program for the treatment of acute & chronic lymphoid malignancies. This protocol has been proposed as a highly efficient treatment for adult ALL with acceptable toxicity profile (Kantarjian HM et al. JCO 2000;18: 3). Purpose: in our Institution, Hyper-CVAD was initiated in September 1999 and uwas sed in the treatment of 20 consecutive adult ALLs. We have analysed and report here our preliminary results focusing on the efficacy and the toxicity of the program. Patients and methods: patient population consisted of 15 de novo ALL (8 T-cell, 7 B-cell), Group A, 3 blastic phase CML (B-cell) and 2 relapsed ALL (B-cell), Group B. M/F ratio was 13/7, median age 40 yrs, mean age 42,5 yrs, range 18-68 yrs. Seven (7/20, 35%) patients were older than 50yrs. Hyperleukocytosis of gtoreq100x109/L was present in 5/20 (25%) cases (3 T-cell, 2 B-cell), while splenomegaly, lymphadenopathy and bulky disease were documented in 16/20(80%), 12/20(60%) and 1/20(5%) of cases respectively. Karyotype was available in 18/20(90%) patients: in 7 was normal, in 1 showed del(12), in 3 CML cases a typical t(9;22), in one just polyploidy and in 6 cases the metaphases were insuffficient. Bcr-abl was positive in one non-CML case. None of the patients presented with CNS disease (by morphology + flowcytometry). Median follow up was 9 months (range 1-29). Results: hematological complete remission was achieved in 11/15 (73,3%) de novo ALL cases (Group A) and in 2/5(40%) relapsed ALL/blastic CML cases (Group B). Resistant disease was documented in 4/20(20%) cases (2 Group A and 2 Group B cases) which subsequently received other therapeutic protocols. Disease progression following initial response was seen in another 3 cases. Three (3/6,50%) evaluable T-ALL cases relapsed, 2 during the consolidation phase and 1 during maintenance. Toxic deaths occured in 3/17(17,6%) cases, two of them in remission and one in early induction. CNS involvement whilst on Hyper-CVAD was not detected in the subgroup of resistant/progressive patients. 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, albeight at a lower than expected magnitude, in accordance with other reports (Lozada JA et al, Blood 2000;96:11, Abstr.4654). 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 extension to CNS in both responders and non-responders. Different patient and ethnic characteristics may account for the disparate results found in our study compared to the initial report.

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Accession: 035980325

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