57809
document
Treatment of adults with acute lymphoblastic leukemia : do the specifics of the regimen matter ? : Results from a prospective randomized trial . BACKGROUND Induction therapy for adults with acute lymphoblastic leukemia ( ALL ) is similar across essentially all regimens , comprised of vincristine , corticosteroids , and anthracyclines intensified with cyclophosphamide , asparaginase , or both . Given the lack of randomized data , to date , no regimen has emerged as standard . The authors previously evaluated cytarabine 3 g/m ( 2 ) daily for 5 days with mitoxantrone 80 mg/m ( 2 ) ( the ALL-2 regimen ) as a novel induction regimen . Compared with historic controls , the ALL-2 regimen was superior in terms of incidence of complete remission , failure with resistant disease , and activity in patients with Philadelphia chromosome ( Ph ) -positive ALL . METHODS The authors conducted a multicenter , prospective , randomized trial of the ALL-2 regimen compared with a standard 4-drug induction ( the L-20 regimen ) . Patients also received consolidation , maintenance therapy , and central nervous system prophylaxis . The trial accrued patients from August 1996 to October 2004 . RESULTS The median follow-up for survivors was 7 years , and the median patient age was 43 years . Responses were evaluated in 164 patients . The treatment arms were balanced in terms of pretreatment characteristics . The frequency of complete remission for the ALL-2 regimen versus the L-20 regimen was 83 % versus 71 % ( P = .06 ) . More patients on the L-20 arm failed with resistant disease ( 21 % vs 8 % ; P = .02 ) . Induction deaths were comparable at 9 % ( ALL-2 ) versus 7 % ( L-20 ) . The median survival was similar ; and , at 5 years , the survival rate was 33 % alive on the ALL-2 arm versus 27 % on the L-20 . CONCLUSIONS Despite superior results of induction therapy with the ALL-2 regimen , this treatment did not improve long-term outcomes . When coupled to the reported experience of other studies in adults with ALL , the results of this randomized trial raise the possibility that ultimate outcomes in adult ALL may be independent of the specific regimen chosen . Cancer 2013 . © 2012 American Cancer Society .
57810
Intervention_Pharmacological
vincristine , corticosteroids , and anthracyclines intensified with cyclophosphamide , asparaginase , or both
57811
Intervention_Pharmacological
cytarabine
57812
Intervention_Pharmacological
mitoxantrone
57813
Intervention_Pharmacological
4-drug induction ( the L-20 regimen ) .
57814
Intervention_Pharmacological
consolidation , maintenance therapy , and central nervous system prophylaxis
57815
Outcome_Mortality
median follow-up for survivors
57816
Outcome_Physical
frequency of complete remission
57817
Outcome_Physical
resistant disease
57818
Outcome_Mortality
Induction deaths
57819
Outcome_Mortality
median survival
57820
Outcome_Mortality
survival rate
57821
Outcome_Other
long-term outcomes
57822
Participant_Age
adults
57823
Participant_Condition
acute lymphoblastic leukemia
57824
Participant_Age
median patient age was 43 years
57825
Participant_Sample-size
164