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Intensified consolidation therapy with dose-escalated doxorubicin did not improve the prognosis of adults with acute lymphoblastic leukemia: the JALSG-ALL97 study

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Abstract

We designed a treatment protocol for newly diagnosed adult acute lymphoblastic leukemia (ALL) in the pre-imatinib era, employing intensified consolidation therapy with a total of 330 mg/m2 doxorubicin and adopting slightly modified induction and maintenance regimen of the CALGB 8811 study. Of 404 eligible patients (median age 38 years, range 15–64 years), 298 (74%) achieved complete remission (CR). The 5-year overall survival (OS) rate was 32%, and the 5-year disease-free survival (DFS) rate was 33%. Of 256 Philadelphia chromosome (Ph)-negative patients, 208 (81%) achieved CR and the 5-year OS rate was 39%, and 60 of them underwent allogeneic-hematopoietic stem cell transplantation (allo-HSCT) from related or unrelated donors during the first CR, resulting in 63% 5-year OS. Of 116 Ph-positive patients, 65 (56%) achieved CR and the 5-year OS rate was 15%, and 22 of them underwent allo-HSCT from related or unrelated donors during the first CR, resulting in 47% 5-year OS. In Ph-negative patients, multivariate analysis showed that older age, advanced performance status and unfavorable karyotypes were significant poor prognostic factors for OS and higher WBC counts for DFS. The present treatment regimen could not show a better outcome than that of our previous JALSG-ALL93 study for adult ALL.

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Acknowledgments

The authors would like to thank all participating physicians from the following institutions in the JALSG-ALL97 study for their cooperation: Nihon University School of Medicine, Tokyo Metropolitan Komagome Hospital, Nagoya University Graduate School of Medicine, Toyota Memorial Hospital, Tajimi Hospital, Meitetsu Hospital, Okazaki City Hospital, Yokkaichi Municipal Hospital, Hekinan Municipal Hospital, National Center for Geriatrics and Gerontology, Tosei General Hospital, Fujita Health University School of Medicine, Mie University Graduate School of Medicine, Matsusaka City Hospital, Takeuchi Hospital, Kinki University School of Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Hiroshima Red Cross Hospital, Nagasaki University Graduate School of Biomedical Sciences, Sasebo City General Hospital, Kumamoto University Graduate School of Medical Sciences, NTT West Kyushu Hospital, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, National Hospital Organization Minami-Okayama Medical Center, Okayama City Hospital, Kagawa Rosai Hospital, Gunma University Graduate School of Medicine, National Hospital Organization Nishigunma National Hospital, Fujioka General Hospital, National Hospital Organization Takasaki General Medical Center, Fukaya Red Cross Hospital, Kurashiki Central Hospital, Fukui Red Cross Hospital, Shimada Municipal Hospital, National Cancer Center Hospital, Saitama Medical University International Medical Center, Hyogo College of Medicine, National Hospital Organization Osaka National Hospital, Kawasaki Medical School, Chiba University Graduate School of Medicine, Social Insurance Funabashi Central Hospital, Saiseikai Narashino Hospital, Nara Medical University, Jikei University School of Medicine, Dokkyo University School of Medicine, National Hospital Organization Nagoya Medical Center, Kameda Medical Center, Ohta Nishinouchi Hospital, Kochi Medical School, Shiga University of Medical Science, Nagahama Red Cross Hospital, Anjo Kosei Hospital, St. Marianna University School of Medicine, St. Marianna University School of Medicine Yokohama Seibu Hospital, Kyoto Prefectural University of Medicine, Shakaihoken Kobe Central Hospital, Akashi Municipal Hospital, Shinshu University School of Medicine, Hamamatsu University School of Medicine, Seirei Hamamatsu General Hospital, Yaizu City Hospital, Fukuroi Municipal Hospital, Kanazawa University Graduate School of Medical Science, Tokyo Medical University, Kyorin University School of Medicine, Hokkaido University Graduate School of Medicine, Hakodate Municipal Hospital, Kansai Medical University, Maebashi Saiseikai Hospital, Nagoya City University Graduate School of Medical Sciences, Tokai University School of Medicine, Ebina General Hospital, Yamaguchi University School of Medicine, Yamaguchi Prefecture Central Hospital, The Institute of Medical Science-The University of Tokyo, Osaka City University, Osaka University Graduate School of Medicine, Niigata University Graduate School of Medical and Dental Sciences, Almeida Memorial Hospital, National Kyushu Cancer Center, Teikyo University School of Medicine, Teikyo University Mizonokuchi Hospital, Sapporo Hokuyu Hospital, Aichi Medical University, Kitazato University School of Medicine, Yamagata University Faculty of Medicine, Hyogo Cancer Center, National Defense Medical College, Akita University Graduate School of Medicine, Kagawa University Faculty of Medicine. This study was supported in part by Grants for Cancer from the Ministry of Health, Welfare and Labor and by a Grant for the Cancer Translational Research Project from the Ministry of Education, Culture, Sports, Science and Technology, Government of Japan.

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Authors and Affiliations

  1. Department of Health Evaluation, Ogawa Red Cross Hospital, 1525-Ogawa, Ogawa-machi, Hiki-gun, Saitama, 355-0397, Japan

    Itsuro Jinnai

  2. Department of Hematology, International Medical Center, Saitama Medical University, Hidaka, Japan

    Itsuro Jinnai & Fumiharu Yagasaki

  3. Department of Hematology, Maebashi Saiseikai Hospital, Maebashi, Japan

    Tohru Sakura

  4. Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan

    Motohiro Tsuzuki

  5. Division of Hematology, Kinki University School of Medicine, Osaka-Sayama, Japan

    Yasuhiro Maeda

  6. Department of Clinical Oncology and Hematology, Jikei University School of Medicine, Tokyo, Japan

    Noriko Usui

  7. Division of Hematology and Oncology, St. Marianna University School of Medicine, Kawasaki, Japan

    Masayuki Kato

  8. Department of Hematology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

    Hirokazu Okumura

  9. Department of 4th Internal Medicine, Hiroshima Red Cross Hospital, Hiroshima, Japan

    Taiichi Kyo

  10. Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan

    Yasunori Ueda

  11. Department of Hematology, Kansai Medical University, Hirakata, Japan

    Yuji Kishimoto

  12. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Kosuke Tsuboi

  13. Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Shigeo Horiike

  14. Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan

    Jin Takeuchi

  15. Department of Molecular Medicine and Hematology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Masako Iwanaga & Yasushi Miyazaki

  16. Division of Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan

    Shuichi Miyawaki

  17. Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Kazunori Ohnishi

  18. Department of Hematology/Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Tomoki Naoe

  19. Aichi Shukutoku University, Nagoya, Japan

    Ryuzo Ohno

Authors
  1. Itsuro Jinnai
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  2. Tohru Sakura
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  3. Motohiro Tsuzuki
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  4. Yasuhiro Maeda
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  5. Noriko Usui
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  6. Masayuki Kato
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  7. Hirokazu Okumura
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  8. Taiichi Kyo
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  9. Yasunori Ueda
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  10. Yuji Kishimoto
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  11. Fumiharu Yagasaki
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  12. Kosuke Tsuboi
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  13. Shigeo Horiike
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  14. Jin Takeuchi
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  15. Masako Iwanaga
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  16. Yasushi Miyazaki
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  17. Shuichi Miyawaki
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  18. Kazunori Ohnishi
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  19. Tomoki Naoe
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  20. Ryuzo Ohno
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Corresponding author

Correspondence to Itsuro Jinnai.

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Jinnai, I., Sakura, T., Tsuzuki, M. et al. Intensified consolidation therapy with dose-escalated doxorubicin did not improve the prognosis of adults with acute lymphoblastic leukemia: the JALSG-ALL97 study. Int J Hematol 92, 490–502 (2010). https://doi.org/10.1007/s12185-010-0672-z

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  • DOI: https://doi.org/10.1007/s12185-010-0672-z

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