Acute Leukemias - Republican Scientific Medical Library

a 13.2 · Therapy for Younger (15–65 Years) Patients with B-Precursor and T-Lineage ALL 169
Fig. 13.1. Overview on treatment approaches in seven consecutive GMALL studies. SR, standard risk; T, T-ALL; HR, high risk; BMT, bone
marrow transplantation; R, randomization.
13.2.2 Study 05/93
Based on improved knowledge of clinical and biological
features as prognostic factors (PF) and specific effectiveness
of distinct treatment elements in subtypes of
ALL, a subgroup-specific consolidation therapy was initiated
in study 05/93. The trial had four treatment
arms: (1) SR B-precursor ALL (patients without adverse
PF); (2) HR B-precursor ALL (at least one PF); (3) T-
ALL; and (4) older patients above 50 years (Elderly)
(PFs of the trial are listed in Fig. 13.4). The general principle
was to intensify treatment with high-dose methotrexate
(HDM) in SR B-lineage ALL, with cyclophosphamide
(CP) and cytarabine (AC) in T-ALL, and with
HDM and HDAC followed by SCT in HR B-lineage
ALL. Furthermore, there was a randomized comparison
of intensified versus conventional maintenance therapy
in SR and T-ALL.
Twelve hundred patients with a median age of 35
(15–65) years were included. The CR rate was 83% with
Fig. 13.2. Induction therapy in GMALL Study 07/03. DEXA, dexamethasone;
CP, cyclophosphamide; VCR, vincristine; DNR, daunorubicine;
PEG-ASP, PEG-L-asparaginase; MTX, methotrexate; i.th.,
intrathecal; CNS 24 Gy, CNS irradiation; 6-MP, mercaptopurine;
ARAC, cytarabine.
a range of 70% in older patients to 87% in SR B-lineage
ALL (Table 13.2). In T-ALL, immunologic subtypes had
a substantial impact on outcome, with a rate of continuous
complete remission (CCR) of 63% for thymic, 28%
for mature, and 25% for early T-ALL, and ruled out the
prognostic impact of WBC and time to CR.