Possible Prognostic Benefit from ABMT in First Remission Adult Acute Lymphoblastic Leukemia

  • R. Bassan
  • A. Rambaldi
  • T. Lerede
  • E. Di Bona
  • G. Rossi
  • E. Pogliani
  • G. Lambertenghi-Deliliers
  • P. Fabris
  • S. Morandi
  • M. Vespignani
  • T. Izzi
  • G. Corneo
  • P. Viero
  • T. Barbui

Abstract

We analyzed the long-term results of a phase II trial closed in 1993, including ABMT (autologous bone marrow transplant) with post-graft chemotherapy as consolidation therapy for first remission adult ALL patients. Seventy-nine patients in remission after ‘IVAP’ (idarubicin-vincristine-L-asparaginase-prednisone) were to receive 4 consolidation cycles followed by marrow harvest (unpurged), cranial irradiation, and ABMT after BCNU 300 mg/m2, etoposide 900 mg/m2, and melphalan 110 mg/m2 (restricted to patients 15–50 years-old). The ABMT regime was intentionally of „limited“ intensity, to minimize the risks of toxic death and to resume promptly continuation therapy with alternate drug pairs for 12 weeks and low-dose maintenance with mercaptopurine and methotrexate for 6 mos. (ABMT) or 18 mos. (no ABMT). At the end of early consolidation 67 patients were alive and still in CR: 10 underwent an allogeneic BMT, 32/47 aged <50 years had an ABMT, and 10 aged >50 years had chemotherapy without transplants. Long-term disease-free survival was positively affected by the following variables: age <35 years /blast count <25×109/l (P<0.001), good treatment realization score (P<0.001), t(9:22)/BCR-ABL negativity (P<0.01), allogeneic BMT and ABMT (P P<0.01, P<0.005), and pre-B CD10+ phenotype (P<0.05). The 5-year DFS rate was 73% for standard-risk patients (age <35, blast count <25×109/l, and Ph/BCR negativity) receiving treatment without major alterations/attenuation and therefore including ABMT in most instances (P<0.001). However, the prognosis of high-risk cases was uniformly poor. This analyis suggested a possible prognostic benefit from ABMT followed by further chemotherapy in standard-risk adult ALL. However, because treatment was scarcely effective in high-risk ALL and good DFS results can be obtained without ABMT in standard-risk cases, the exact role of this therapeutic procedure in specific risk classes remains undetermined.

Keywords

Toxicity Leukemia Doxorubicin Methotrexate Melphalan 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • R. Bassan
    • 1
  • A. Rambaldi
    • 1
  • T. Lerede
    • 1
  • E. Di Bona
    • 2
  • G. Rossi
    • 3
  • E. Pogliani
    • 4
  • G. Lambertenghi-Deliliers
    • 5
  • P. Fabris
    • 6
  • S. Morandi
    • 7
  • M. Vespignani
    • 8
  • T. Izzi
    • 4
  • G. Corneo
    • 5
  • P. Viero
    • 1
  • T. Barbui
    • 1
  1. 1.Ospedali RiunitiHematology/Bone Marrow Transplant UnitBergamoItaly
  2. 2.Ospedale Civile San BortoloHematology/Bone Marrow Transplant UnitVicenzaItaly
  3. 3.Spedali CiviliHematology/Bone Marrow Transplant UnitBresciaItaly
  4. 4.Nuovo Ospedale San GerardoHematology/Bone Marrow Transplant UnitMonzaItaly
  5. 5.Clinica MedicaHematology/Bone Marrow Transplant Unit, Università degli StudiMilanItaly
  6. 6.Ospedale CivileHematology/Bone Marrow Transplant UnitBolzanoItaly
  7. 7.Ospedale CivileHematology/Bone Marrow Transplant UnitCremonaItaly
  8. 8.Ospedale CivileHematology/Bone Marrow Transplant UnitVeneziaItaly

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