The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia

被引:70
作者
Koller, CA [1 ]
Kantarjian, HM [1 ]
Thomas, D [1 ]
O'Brien, S [1 ]
Rios, MB [1 ]
Kornblau, S [1 ]
Murphy, S [1 ]
Keating, M [1 ]
机构
[1] Univ Texas, MD Anderson Canc Ctr, Dept Hematol, Leukemia Sect, Houston, TX 77030 USA
关键词
acute lymphoblastic leukemia; treatment; reinduction regimens; remission;
D O I
10.1038/sj.leu.2400861
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Sixty-six adults with refractory acute lymphocytic leukemia received salvage therapy with the 'hyper-CVAD' regimen, consisting of eight courses of alternating intensive chemotherapy with growth factor support, followed by oral maintenance chemotherapy. Their outcome was compared with 63 prognostically similar historical control patients treated with high-dose Ara-C plus mitoxantrone with or without GM-CSF. Overall, the complete response rates were similar in the treatment and control groups (29 of 66 (44%) vs 24 of 63 (38%)). There were more patients in the current study with primary resistant disease (10 of 66 (15%) vs one of 63 (2%), P = 0.006), and conversely fewer patients with secondary resistance (19 of 66 (29%) vs 28 of 63 (44%), P = 0.06). Recovery of granulocyte counts above 500/mu l was significantly faster in the current study when compared to high-dose Ara-C-treated patients who were given GM CSF (20 vs 25 days, P = 0.04). Survival was prolonged in the hyper-CVAD-treated patients, with most of the benefit seen in first salvage patients (42 vs 20 weeks, P = 0.016). When only first salvage patients were considered, there was a significant difference in disease-free survival in favor of hyper-CVAD (52 vs 20 weeks, P = 0.008). The hyper-CVAD regimen is a more effective and less toxic salvage regimen for relapsed acute lymphocytic leukemia than high-dose Ara-C-based regimens.
引用
收藏
页码:2039 / 2044
页数:6
相关论文
共 25 条
[1]   4-AGENT INDUCTION AND INTENSIVE ASPARAGINASE THERAPY FOR TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA [J].
CLAVELL, LA ;
GELBER, RD ;
COHEN, HJ ;
HITCHCOCKBRYAN, S ;
CASSADY, JR ;
TARBELL, NJ ;
BLATTNER, SR ;
TANTRAVAHI, R ;
LEAVITT, P ;
SALLAN, SE .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 315 (11) :657-663
[2]   THE BIOLOGY AND TREATMENT OF ACUTE LYMPHOBLASTIC-LEUKEMIA IN ADULTS [J].
COPELAN, EA ;
MCGUIRE, EA .
BLOOD, 1995, 85 (05) :1151-1168
[3]  
Cortes J, 1995, BLOOD, V86, P1739
[4]  
CORTES JE, 1995, CANCER-AM CANCER SOC, V76, P2393, DOI 10.1002/1097-0142(19951215)76:12<2393::AID-CNCR2820761203>3.0.CO
[5]  
2-P
[6]  
ESTEY EH, 1983, CANCER TREAT REP, V67, P389
[7]  
FREUND M, 1992, CANCER-AM CANCER SOC, V69, P709, DOI 10.1002/1097-0142(19920201)69:3<709::AID-CNCR2820690318>3.0.CO
[8]  
2-G
[9]  
GEHAN EA, 1965, BIOMETRIKA, V52, P203, DOI 10.1093/biomet/52.1-2.203
[10]  
KANTARJIAN HM, 1992, BLOOD, V79, P876