Acute Leukemias - Republican Scientific Medical Library

a 15.4 · Current Treatment of Newly Diagnosed L 3ALL in Adults 195
Table 15.2. Principles of BFM 90 trial
Prephase Prednisone (orally/IV) 30 mg/m 2
Cyclophosphamide (IV 1 h) 200 mg/m 2
Methotrexate IT 12 mg d 1
Cytarabine IT 30 mg d 1
Prednisolone IT 10 mg d1
Course A Dexamethasone (orally/IV) 10 mg/m 2
Ifosfamide (IV 1 h) 800 mg/m 2
Methotrexate IV 24 h 5 g/m 2
involved the CNS in 57% cases, and the marrow in 43%
of the cases. Forty nine per cent of the patients were
eventually considered to be cured of their disease. Subsequently,
this group used another trial, with higher
doses of MTX, of VM26 and Ara C (B-NHL 86). With
this trial, the CR rate slightly increased to 74%, and
the relapse rate dropped to 23%. Furthermore, only
17% of the relapses involved the CNS. Long-term survival,
however, was similar (51%) in the B-NHL 86 trial, due
in part to older age of patients and death from allogeneic
BMT in two cases. In studies B-NHL 83 and B-
NHL 86, five patients were allografted, four in first CR
and one in PR, and one was autografted in first CR.
Three allografted patients died, two from toxicity and
the patient who had achieved PR from progressive disease.
Those results, like results of the French group,
d1 to d5
d 1 to d 5
d1 to d5
d1 to d5
Methotrexate IT 6 mg d4 and d6
Cytarabine IT 15 mg d 1 and d 6
Prednisolone IT 5 mg d1 and d6 Vincristine IV 1.5 mg/m 2
Cytarabine IV 1 h 150 mg/m 2
Etoposide IV 1 h 100 mg/m 2
Course B Dexamethasone 10 mg/m 2
Cyclophosphamide (IV 1 h) 200 mg/m 2
Methotrexate IV 24 h 5 g/m 2
confirmed that allogeneic BMT seems to have no or limited
place in the first line treatment of L 3ALL.
The CALGB chose to adapt the German adult ALL
protocol where etoposide replaced teniposide. Patients
with an L3ALL or a Burkitt lymphoma with a CNS involvement
were included in two successive phase II
trials [13, 14]. For L 3ALL, 18 out of the 24 patients
reached CR (75%). Seven of them relapsed. Overall survival
for L 3ALL was 45% with a median follow-up of
5 years. Most of the relapsing occurred during the first
year. Only two patients experienced relapse more than
1 year after the start of therapy. CNS prophylaxis was
modified between these two successive trials. The initial
trial planned 12 doses of triple intrathecal chemotherapy
combined with early radiotherapy (given halfway
through therapy). A high neurological toxicity was ob-
d1
d 1
d4 and d5
d4 and d5
d1 to d5
d1 to d5
Methotrexate IT 6 mg d 1 and d 6
Cytarabine IT 15 mg d 1 and d 6
Prednisolone IT 5 mg d1 and d6 Vincristine IV 1.5 mg/m 2
Doxorubicin IV 1 h 25 mg/m 2
Patients with L 3ALL receive six courses alternating A and B (ABABAB).
d 1
d1
d4 and d5