Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

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Abstract
The clinical outlook for adults with acute lymphoblastic leukemia (ALL) has Improved with the use of intensive chemotherapy. Complete remissions (CR) are achieved in 80% of adults but the majority relapse on maintenance chemotherapy and a few exhibit primary resistance to induction therapy. This report compares the various salvage treatments and provides guidance in selecting a regimen with the optimum clinical outcome. Regimens using high-dose ara-C (HDAC) in combination with mltoxantrone, amsacrine, or idarublcin are superior to HDAC alone or with L-asparaginase. The sequential administration of methotrexate and L-asparaginase Is equally effective. The duration of second CR is short for all chemotherapeutic regimens.

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