COMBINATION CHEMOTHERAPY OF ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA WITH RANDOMIZED CENTRAL NERVOUS-SYSTEM PROPHYLAXIS

  • 1 January 1980
    • journal article
    • research article
    • Vol. 55  (2) , 199-204
Abstract
Although major progress has been made in the treatment of childhood leukemia, the optimal chemotherapy of acute lymphoblastic leukemia (ALL) in adults has been unclear. In addition, the value of CNS prophylaxis (CNS-P) in adults has been assumed, but not established in a systematic fashion. A prospective study was completed in which vincristine plus low-dose methotrexate and high-dose prednisone in adult All produced an 80% (79/99) complete remission rate in patients age 15 yr and over. Younger patients had a significantly higher remission rate but no increase in remission duration. This induction regimen was associated with minimal toxicity. Random assignment to CNS-P or to no prophylaxis, after a multidrug consolidation regimen, demonstrated a significant prolongation of CNS relapse-free interval (P = 0.008) in favor of CNS-P. CNS-P did not improve hematologic remission duration or survival. All complete remitters were maintained on mercaptopurine, methotrexate and cyclophosphamide with pulses of prednisone and vincristine; the median time from remission to hematologic or CNS relapse was 19.3 mo. after CNS-P, and survival for these patients was 26.1 mo. This induction regimen is highly effective in adult ALL and CNS-P is indicated in such patients.