12th Congress of the European Hematology ... - Haematologica

ecently suggested (Boissel et al., J Clin Oncol 2003). 3) Whether this
could also be applied to young adults is currently under testing.
Table 1.
0374
RISK ADAPTED TREATMENT OF ADOLESCENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA
(ALL) ACCORDING THE GERMAN MULTICENTER STUDY GROUP (GMALL) STUDIES 06/99
AND 07/03 YIELDS SIGNIFICANTLY DIFFERENT OUTCOME FOR SUBGROUPS
N. Goekbuget, 1 R. Arnold, 2 A. Böhme, 1 R. Fietkau, 3 M. Freund, 3
A. Ganser, 3 M. Kneba, 3 T. Lipp, 4 W.-D. Ludwig, 3 G. Maschmeyer, 5
D. Messerer, 6 H. Rieder, 3 E. Thiel, 2 D. Hoelzer1 1 J.W.Goethe University, FRANKFURT AM MAIN; 2 University Hospital Charité,
BERLIN; 3 University Hospital, ROSTOCK; 4 Krankenhaus Schwabing,
MÜNCHEN; 5 Klinikum Ernst von Bergmann, POTSDAM; 6IBE, University,
MUNICH, Germany
In the recent years several groups have reported treatment results in
adolescents with ALL. Outcome with protocols for adults (EFS 34-71%)
were generally inferior compared to pediatric protocols (EFS 64-80%)
(S.Sallan, ASH Education 2006). The conclusion was that pediatric trials
include higher doses of VCR, ASP and HDMTX and a higher time-dose
intensity. However the poor outcomes of most compared adult protocols
are probably also due to suboptimal approaches in these specific
studies e.g. stem cell transplantation (SCT) in all pts with donor. The
GMALL started in 1999 the study 06/99 followed by 07/03 with minor
changes. Induction is based on DEXA, DNR, VCR, PEG-ASP and standard
phase II. All pts received HDMTX/HDAC based consolidation1.
High risk (HR) pts (B-lineage ALL with WBC>30.000 or late CR, pro-B,
earlyT, mature T, t(4;11), t(9;22)) were allocated to allogeneic SCT. Standard
risk (SR) pts received consolidation with HDMTX/ASP (3x),
VM26/ARAC, CYCLO/ARAC and reinduction. Since 2003 most pts
with Ph+ received Imatinib. Between 9/99 and 12/06 1514 pts were
included. 417 (28%) were adolescents aged 15-25 yrs (18% 15-17, 41%
18-20 and 41% 21-25 yrs). Of those 58% were SR, 34% HR and 8% Ph+.
Immunophenotypes were c/preB(63%), proB(5%), earlyT(7%)
matureT(7%) and thymicT(18%). Entry criteria showed no differences
for the three age groups. The CR rate was 90% (87% after phase I; 93%,
92% and 88% for the 3 age groups). 2% died in induction; 7% failed.
The overall survival (OS) was 64%, 67% in CR pts and the relapse free
survival 54%. OS according to age was 68%, 62% and 65%. CR rates
and OS differed significantly for risk groups and subtypes. OS was 74%
for SR, 49% for HR and 55% for Ph + (p