The Total Therapy Of Acute Lymphoblastic Leukemia

Objective:The best treatment is not clear for adults with acute lymphoblastic leukemia(ALL)after the first complete remission(CR1)under different risk stratification.The purpose of our study was to indentify the optimal treatment model after CRI.Methods:Patient characteristics and survival information were analyzed.Minimal residual disease(MRD)was tested using multicolor cytofluorometry.Results:Of registered patients,the median age was 24 years old(range:15?59 years).The CR rate was 88.5%at the first induction.The CR rate was superior in patients with B-ALL,not with T-ALL.Intent-to-treat analysis was done for prognosis in patients with Philadephia chromosome-negative ALL.By univariate analysis,poor relapse-free survival(RFS)associated with T-ALL,high white blood cell count,chemotherapy,MRD.For patients at standard-risk in autograft hematopoietic stem cell transplantation(AHSCT).allogeneic hematopoietic stem cell transplantation(allo-HSCT),chemotherapy,the median RFS/enent-free survival(EFS)/overall survival(OS)were not-reached/not-reached/not-reached,not-reached/25 months/40 months,24 months/24 months/34 months,respectively.Superiority in AHSCT were in patients with ph-ALL at stardard-risk for EFS and OS.For patients at high-risk in AHSCT,allo-HSCT,chemotherapy,the median RFS/EFS/OS were 41 months/41 months/56 months,not-reached/not-reached/not-reached,42 months/42 months/48 months,respectively.For patients at very high-risk in AHSCT,allo-HSCT,chemotherapy,the median RFS/EFS/OS were 44 months/44 months/59 months,not-reached/48 months/57 months,19 months/19 months/36 months,respectively.No significant survival differences were found in patients at high-risk or very high-risk with AHSCT,allo-HSCT,or chemotherapy.For patients with Philadephia chromosome-negative ALL,all the three cases who received chemotherapy experienced relapse.The 5-year RFS/EFS/OS for patients received allo-HSCT or AHSCT were 70.4%/50.0%,48.1%/50.0%,52.1%/45.0%,respectively.Similar RFS/EFS/OS were found between allo-HSCT and AHSCT.One hundred and eleven patients had evaluable MRD at the end of induction and consolidation.For patients with MRD positive after induction,superior five-year RFS was found in allo-HSCT,not in chemotherapy or AHSCT(92.3%vs.20.0%vs.23.8%,P=0.001).For patients with MRD negative,similar outcomes for RFS was found in AHSCT and allo-HSCT.Treatment-related death occurred in 14 patients(4 in induction,1 in early intensification,9 after allo-HSCT).The main cause of treatment-related death was infection(n=12).Conclusions:The survival of adults with ALL would improve through standardized inductive treatment and early intensified consolidation,followed AHSCT or allo-HSCT according to risk stratification.Dynamic monitoring of MRD during treatment,associated with risk stratification at diagnosis,can better guide further treatment.BDHALL2000 02/03 regimen was considered to be safe and controllable.