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

Abstract

Sixty-six adults with refractory acute lymphocytic leukemia received salvage therapy with the 'hyper-CVAD' regimen, consisting of eight courses of alternating intensive chemotherapy with growth factor support, followed by oral maintenance chemotherapy. Their outcome was compared with 63 prognostically similar historical control patients treated with high-dose Ara-C plus mitoxantrone with or without GM-CSF. Overall, the complete response rates were similar in the treatment and control groups (29 of 66 (44%) vs 24 of 63 (38%)). There were more patients in the current study with primary resistant disease (10 of 66 (15%) vs one of 63 (2%), P = 0.006), and conversely fewer patients with secondary resistance (19 of 66 (29%) vs 28 of 63 (44%), P = 0.06). Recovery of granulocyte counts above 500/l was significantly faster in the current study when compared to high-dose Ara-C-treated patients who were given GM-CSF (20 vs 25 days, P = 0.04). Survival was prolonged in the hyper-CVAD-treated patients, with most of the benefit seen in first salvage patients (42 vs 20 weeks, P = 0.016). When only first salvage patients were considered, there was a significant difference in disease-free survival in favor of hyper-CVAD (52 vs 20 weeks, P = 0.008). The hyper-CVAD regimen is a more effective and less toxic salvage regimen for relapsed acute lymphocytic leukemia than high-dose Ara-C-based regimens.

Adult Refractory Chronic Idiopathic Thrombocytopenic Purpura: Can Dapsone Be Proposed as Second‐line Therapy?

“…A recent report from Koller et al (1997) on the treatment of 66 adults with acute lymphoblastic leukaemia using the hyperCVAD regimen showed promising results. Neurotoxicity was not reported in that study.…”

Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia

“…2 Moreover, although this may be comparable with rates observed with hyper-CVAD or augmented hyper-CVAD protocols (44% to 60%), 3,4 it should be recognized that CR/CRp in these previous studies were achieved sometimes after several cycles and not one, as evaluated here. Disease improvement provided by the Cheprall regimen was, however, short-lived, which could be explained by an insufficient decrease in disease load and/or by failure of the blast cells to respond to epratuzumab.…”

“…Patrice Chevallier, 1 Sylvain Chantepie, 2 Francoise Huguet, 3 Emmanuel Raffoux, 4 Xavier Thomas, 5 Thibaut Leguay, 6 Tony Marchand, 7 Francoise Isnard, 8 …”

Eradication of residual bcr-abl-positive clones by inducing graft-versus-host disease after allogeneic stem cell transplantation in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

“…The patient had t(9;22)(q11;q34) with both minor and major bcr-abl mRNA. Treatment with the L10/M 17 protocol 12 and two courses of hyper-CVAD 13 as salvage therapy were unsuccessful. She was referred to our hospital for unrelated allogeneic BMT using the Japan Marrow Donor Program (JMDP).…”