Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group

Abstract

BackgroundAbout one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia. Design and MethodsWe analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials. ResultsThe median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%). ConclusionsThe prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available. Group. Haematologica. 2010;95:589-596. doi:10.3324/haematol.2009 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group

Clofarabine‐based chemotherapy for relapsed/refractory adult acute lymphoblastic leukemia and lymphoblastic lymphoma. The Spanish experience

“…These results compare favorably with the other relatively large clofarabine study conducted in the adult setting which reported a CR rate of 15% [14]. Other studies evaluating classical ALL salvage regimens reported CR rates between 18 and 75% with less than 20% of long-term survivors [4][5][6]. The duration of CR in our patients was similar than in other studies performed in adults [15] but shorter than in the pediatric studies [13], probably due to the worse disease prognosis in the former.…”

“…Most classical salvage regimens include several drugs used as first-line treatment with disappointing results. Noteworthy, the reported long-term survival for ALL patients beyond first relapse appears to be lower than 20% [3][4][5]. Commonly, these patients do not reach an allo-HCT due to chemoresistance to salvage regimen or to a very short lasting CR2, with relapse occurring before the identification of a suitable donor [6].…”

“…There is an extensive literature regarding PCP referrals for solid tumors, especially for malignancies such as breast and gastrointestinal cancer where there are abundant evidence-based screening guidelines [1][2][3][4]. In contrast, little is known about referrals for suspected hematologic malignancies [5], such as the frequency of such referrals, their clinical triggers, the factors that influence the choice of hematologist, and the quality of information exchanged.…”

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“…Compared to childhood leukemia, the clinical picture for adult T-ALL is even worse, with high relapse rates and long-term disease-free survival of about 40% (5)(6)(7). Altogether, these figures suggest that better and less toxic treatment strategies are urgently required to further improve the clinical management of childhood and adult T-ALL patients.…”

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“…Adult patients with relapsed or refractory ALL have a poor prognosis and almost all patients will die from their disease [21][22][23][24][25][26][27][28]. While children are initially more responsive to traditional salvage chemotherapy approaches than adults, these remissions are often not sustained and relapsed ALL remains a leading cause of cancer deaths in children [29,30].…”