A comparative study of combination chemotherapy versus marrow transplant in first remission in adult acute lymphoblastic leukaemia

Abstract

The results of conventional chemotherapy in adult acute lymphoblastic leukaemia (ALL) have not improved substantially in recent years. The present study is based on a flexible policy of marrow transplantation (allograft and autograft without marrow purging) in first remission compared with a group treated with standard maintenance therapy after a common induction sequence. The actuarial disease free survival (DFS) and actuarial overall survival (OS) at 3 years for autologous marrow grafted patients was 30% and 65% respectively. The allogeneic transplant group had DFS of 30% and OS at 3 years of 38% compared with DFS (12%) and OS (12%) for patients on 6-mercaptopurine and methotrexate maintenance. The actuarial disease free survival calculations include patients on protocol not entering remission, therefore, giving the worst possible result. We conclude that high dose chemo/radiotherapy with autologous marrow rescue in first remission followed by no maintenance provides better results in terms of overall survival and quality of life than standard ALL maintenance in adult patients. Results for allogeneic transplant in ALL are less good in terms of duration and quality of survival and the majority of deaths are related to causes other than leukaemic relapse.

A population-based cytogenetic study of adults with acute lymphoblastic leukemia

“…14,15 Occasionally, patients were treated according to, but not registered on, national protocols (UKALLXII, UKALLXA). 16,17 Acute biphenotypic leukemia was defined as terminal deoxynucleotidyl transferase (TdT)-positive patients who also expressed some myeloid antigens.…”

“…In 1984, routine standard maintenance was discontinued for patients younger than 55 years of age and instead these patients were offered, in first remission, an allogeneic transplant or, in the absence of a family donor, an autologous transplant. 14 Patients younger than 45 years of age underwent a preconditioning regimen of cyclophosphamide (60 mg/kg) and total-body irradiation (1200 cGy), and those aged 45 to 55 years received melphalan (3 mg/kg), total-body irradiation (1050 cGy), and noncryopreserved marrow rescue.…”

Autologous bone marrow transplantation in poor-risk high-grade non-Hodgkin's lymphoma in first complete remission

“…The effiacy, low procedural morbidity, absent mortality and encouraging results associated with unmanipulated non-opreserved ABMT in patients with acute lymphoblastic with high-grade NHL were perceived to be at high risk of kaemia (Proctor et al, 1988) prompted this phase II study relapse following conventional therapy using criteria similar NBMT in NHL patients in first CR (some of whom have to those identified by Coleman et al (1986). Although the ady been reported; Carey et al, 1991 form of preconditioning, neverthels the trend of improved event-free survival for such difficult patients remains encouraging.…”

Molecular remission in Philadelphia-positive adult acute lymphoblastic leukaemia rapidly induced by conventional-dose chemotherapy

“…During the first month he was given MIDAC consolidation, remission samples were tworound negative. The relationship between the unusual the induction schedule according to the Regional Protocol (NEALL III) 5 utilising vincristine, cytosine arabinoside, molecular biological profile of this leukaemia and the rapid attainment of molecular remission is discussed.…”

“…In our experience of using one-round PCR methods to detect bcr/abl transcripts in a panel of adult Figure 1 The induction chemotherapy consisted of NE ALL III therapy. 5 Consolidation in month II was MIDAC following which molecular remission was achieved and sustained after FLAG chemotherapy in Month III. Subsequently, Month IV was treatment-free and during Month V allogeneic transplant was performed utilising melphalan 3 mg/kg × 1 and TBI 1200 cGy (six fractions) pre-conditioning.…”