Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

Abstract

The clinical outlook for adults with acute lymphoblastic leukemia (ALL) has improved with the use of intensive chemotherapy. Complete remissions (CR) are achieved in 80% of adults but the majority relapse on maintenance chemotherapy and a few exhibit primary resistance to induction therapy. This report compares the various salvage treatments and provides guidance in selecting a regimen with the optimum clinical outcome. Regimens using high-dose ara-C (HDAC) in combination with mitoxantrone, amsacrine, or idarubicin are superior to HDAC alone or with L-asparaginase. The sequential administration of methotrexate and L-asparaginase is equally effective. The duration of second CR is short for all chemotherapeutic regimens.

The hyper-CVAD regimen improves outcome in relapsed acute lymphoblastic leukemia

“…[3][4][5] Because most adult patients will relapse after a relatively brief remission, more effective therapeutic approaches are needed. In a recent review by Welborn,6 consisting of a compilation of 44 studies involving 861 patients and using a variety of reinduction treatment regimens for relapsed and refractory ALL, CR rates varied from 5 to 89% but median duration of CR was 6 months or less in all. Furthermore, the median duration of CR for the 44 studies was 3.8 ± 2.1 months.…”

“…Furthermore, the median duration of CR for the 44 studies was 3.8 ± 2.1 months. 6 Schiller et al 14 in a small group of adults with ALL who were refractory to treatment or in …”

“…[3][4][5] Once a patient relapses or fails to achieve a complete remission, salvage chemotherapy regimens have been reported to have reinduction rates of 20-60%, but, nevertheless, median CR remission duration averages only 3.4 months. 6 Over a period of 44 months, 66 patients at our institution were given salvage chemotherapy with the 'hyper-CVAD' regimen, a dose-intensive regimen patterned after the childhood Burkitt ALL therapy designed by Murphy et al 7 We called the regimen 'hyper-CVAD' after the acronym for the initial induction combination. 8 Our findings are summarized in this report.…”

Outcome of treatment after first relapse in adults with acute lymphoblastic leukemia initially treated by the LALA-94 trial

“…Although a second CR can be achieved, the median disease-free survival (DFS) is only 2-7.5 months. [8][9][10][11] It is generally accepted that no cure can be achieved at this stage using chemotherapy alone. The only curative approach is allogeneic SCT.…”

Allogeneic or autologous stem cell transplantation following salvage chemotherapy for adults with refractory or relapsed acute lymphoblastic leukemia

“…1 Although remissions can be obtained in 40-70% of cases with salvage CT, these usually last less than 5 months, regardless of the post-remission therapy used, and with CT alone less than 5% are alive 2 years from the start of salvage CT. 1,2 Both autologous and allogeneic stem cell transplantation (SCT, either bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT)) have been used in such patients as post-remission therapy in an effort to improve the disease-free survival. [3][4][5][6] However, reports from transplant centers or registries usually include heterogeneous patients highly selected either by the transplant center(s), referral for BMT of only 'good-risk' responding cases or exclusion of those cases debilitated by the salvage CT.…”