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Treatment of adult acute lymphocytic leukemia with Hyper-CVAD Experience in a county teaching hospital

Treatment of adult acute lymphocytic leukemia with Hyper-CVAD Experience in a county teaching hospital

Blood 96(11 Part 2): 213b, November 16

Purpose: To report the experience in Ben Taub General Hospital, a county teaching hospital, in treating adult acute lymphocytic leukemia (ALL) with Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Patients and Methods: Between June 1994 and January 2000, 26 adults with newly diagnosed ALL presented to Ben Taub General Hospital in Houston, TX. All patients were treated with Hyper-CVAD. No exclusions were made because of age, performance status, or other medical problems. Median age was 25.5 years; 2 patients (8%) were 50 years or older. T-cell disease was present in 4 (15%); none had mature B-cell disease. Philadelphia chromosome-positive disease was present in 5 (19%). Leukocytosis of more than 30 X 109 was found in 9 (35%), CNS leukemia at diagnosis in 3 (12%), and a mediastinal mass in 2 (8%). Treatment consisted of four cycles of Hyper-CVAD alternating with four cycles of methotrexate and cytarabine. All patients received intrathecal CNS prophylaxis, antibiotic prophylaxis, and granulocyte-colony stimulating factor support. All patients were treated on schedule and at full doses, except one case in which the vincristine was held during courses 3, 5, and 7 due to severe neuropathy. Maintenance therapy consisted of two years of treatment with mercaptopurine, methotrexate, vincristine, and prednisone (POMP). Results: Of the 26 patients, 20 (77%) achieved a complete remission, 2 (8%) died during induction therapy, and 4 (15%) never achieved remission. After a median follow-up time of 20 months (range 1 - 59 mo.), 8 (31%) are still alive, 7 of them in first CR, and one with relapse of disease. Of the 13 patients who relapsed, there was only 1 with relapse in the CNS, 1 with testicular relapse, while the remainder were leukemic relapses. Median survival was 11 months, with an estimated 2-year survival of 40% (standard error 10%). Conclusions: 1- The Hyper-CVAD regimen is effective, and can be safely given in a county hospital setting. 2- The Hyper-CVAD regimen was effective in preventing CNS relapse. 3- The Hyper-CVAD regimen may be particularly effective for T cell ALL. 4- The efficacy was significantly lower than expected compared to prior single-institution reports, despite strict adherence to the treatment schedule. 5- As the presenting characteristics of our patients were very similar to those of other series reported, it is imperative that other factors, such as ethnic background and the biology of the disease itself, be explored as possible causes for this difference in outcome.

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Accession: 035980844

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