IMPROVED TREATMENT OUTCOME IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA USING THE INTENSIVE GERMAN PROTOCOL, - A PRELIMINARY-REPORT

Thirty-nine consecutive patients with acute lymphoblastic leukemia wer e treated with lan intensive chemotherapy protocol. There were 23 male s and 16 females with a median age of 37 years (range: 15-65). Eightee n patients had common ALL, seven had pre-B ALL, three early-precursor B ALL, seven T-ALL and four had aberrant expression of myeloid antigen s (c-ALL in three and pre-B ALL in one). The median initial leukocyte count was 11.8 x 10(9)/1 (range: 0.65-295). Cytogenetic result of the marrow was available in 16 of 39 patients (41 per cent) and showed Phi ladelphia positivity in six, a normal result in six and one each of t( 4,11), t(1,19), hyperdiploidy and del 12p. Hepatosplenomegaly was pres ent in about 20 per cent of the patients. L-Asparaginase-related hepat ic toxicity was the commonest toxicity (48.7 per cent) during phase I of induction. Prolonged pancytopenia and hypoplastic death were common during phase II. With the use of growth factors during the neutropeni c period of phase II induction, the rate of hypoplastic death was redu ced from 40 per cent to 3 per cent. Common causes of treatment failure included early hypoplastic death (27.8 per cent) and leukemia relapse s (50 per cent) while primary refractory leukemia, hepatic failure and perforated peptic ulcer contributed to 11.1, 5.5 and 5.5 per cent of the other deaths. A high complete remission (CR) rate (87.4 per cent) was achieved after phase I induction. The median event-free survival ( EFS) was 8 months and the 3-year event-free survival was 43 per cent. This result compared favourably to the other regimens previously emplo yed in our institution. In conclusion, satisfactory survival can be ac hieved with this intensive regimen. Good supportive care was however, essential to minimize toxicities. (C) 1997 John Wiley & Sons, Ltd.