Acute Leukemias - Republican Scientific Medical Library

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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
196 Chapter 15 · Burkitt’s <strong>Acute</strong> Lymphoblastic Leukemia (L 3ALL) in Adults Table 15.3. Previous experience of treatment of adult L3ALL with specific intensive protocols LFS Survival CR rate Early death rate WBC >50´10 9 /l CNS involvement Median age Protocol No. of patients Author (year of publication) Fenaux (1989) SFOP86 9 38 100% 11% 8/9 1/9 2/8 relapses 6/9 long survivors Soussain SFOP84 24 NK 33% NK 9/24 2/24 14/19 leuke- 14/24 long survivors (1995) SFOP86 mia free Hoelzer (1996) B-NHL83 24 33 8% 17% 63% 8% 50% at 4 years 49% at 4 years B-NHL86 35 36 17% 20% 74% 9% 71% at 4 years 51% at 4 years Pees (1992) BFM-NHL 5 35 2/5 NK 3/5 1/5 no relapse 3/5 long survivors POG 6 35 1/6 NK 6/6 0 no relapse 6/6 long survivors Todeschini (1997) HyperCVAD 11 NK NK NK 8/11 NK 33% 5 year survival Kantarjian (1999) Lee (2001) Modified BFM 24 NK NK NK 8/11 NK 33% 5 year survival Cabanillas (1) R-HyperCVAD 20 52 17% NK 89% 0 12/14 non-HIV NK (2003) at 12 months R-GMALL 11 NK NK NK 91% 1/11 NK NK Hoelzer (2) (2003) NK: not known. 1-including Burkitt and Burkitt-like lymphomas (with 6/20 HIV patients). Including Rituximab and HyperCVAD2-including 82 patients with 11 mature B-ALL. Rituximab was added to German GMALL regimen.
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E.H. Estey · S.H. Faderl · H. M.
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E. H. Estey Department of Leukemia
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VI Table of Contents 14 Philadelphi
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VIII Contributors S. H. Faderl Depa
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X Contributors D. Wartenberg Depart
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Therapy of AML Elihu Estey Contents
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a 1.2 · Standard Therapy 3 Table 1
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a 1.2 · Standard Therapy 5 Table 1
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a 1.2 · Standard Therapy 7 tween G
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a 1.2 · Standard Therapy 9 Fig. 1.
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a 1.2 · Standard Therapy 11 of tre
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a 1.2 · Standard Therapy 13 Table
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a 1.2 · Standard Therapy 15 permit
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a References 17 19. Care RS, Valk P
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a References 19 6-thioguanine in th
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Acute Myeloid Leukemia: Epidemiolog
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a 3.1 · Epidemiology 49 3.1.4 Gend
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a 3.2 · Etiology 51 part of the in
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a 3.2 · Etiology 53 for the develo
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a References 55 38. Crane MM, Stom
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Relapsed and Refractory Acute Myelo
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a 4.2 · Prognostic Factors in Pati
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a 4.3 · Treatment of Relapsed and
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a 4.4 · Hematopoietic Stem Cell Tr
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a 4.6 · Gemtuzumab Ozogamicin 65 T
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a 4.7 · Relapsed and Refractory Ac
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a 4.7 · Relapsed and Refractory Ac
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a References 71 The ability of immu
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a References 73 39. Vogler WR, McCa
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a References 75 95. Sievers EL, Lar
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Part II - Acute Lymphoblastic Leuke
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78 Chapter 5 · Acute Lymphoblastic
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Molecular Biology and Genetics Meir
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a 6.3 · Structural Aberrations 97
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a 6.3 · Structural Aberrations 99
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a 6.5 · Molecular Aberrations 101
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a References 103 clear that homozyg
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a References 105 53. Chim CS, Tam C
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a References 107 122. Lennard L, Li
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Diagnosis of Acute Lymphoblastic Le
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a 8.3 · Cytochemistry and Immunoph
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a 8.5 · Cytogenetic and Molecular
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a 8.5 · Cytogenetic and Molecular
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a References 127 including the reti
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a References 129 47. Kita K, Shirak
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Acute Lymphoblastic Leukemia: Clini
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a 7.3 · Diagnosis 111 or neoplasti
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a 7.3 · Diagnosis 113 Fig. 7.2. Hi
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a 7.3 · Diagnosis 115 The vast maj
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a References 117 dren: Biologic bas
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General Approach to the Therapy of
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a 9.3 · New Agents 133 dose methot
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a References 135 4. Gökbuget N, Ho
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138 Chapter 10 · Recent Clinical T
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140 Chapter 10 · Recent Clinical T
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Page 143 and 144: ALL Therapy: Review of the MD Ander
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Page 149 and 150: Treatment of Adult ALL According to
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Page 159 and 160: Philadelphia Chromosome-Positive Ac
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Page 171 and 172: a References 189 acute lymphoblasti
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246 Chapter 19 · Novel Therapies i
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248 Chapter 20 · Minimal Residual
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264 Chapter 21 · Central Nervous S
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276 Chapter 22 · Relapsed Acute Ly
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278 Chapter 22 · Relapsed Acute Ly
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Emergencies in Acute Lymphoblastic
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a 23.5 · Hyperleukocytosis 283 LA
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a 23.9 · Neurological Complication
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a References 287 29. Hingorani AD,
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Subject Index A aberrant methylatio
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a Subject Index 291 CREB, see enhan
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a Subject Index 293 MUD, see matche
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