THERAPEUTIC IMPACT OF ADULT-TYPE ACUTE LYMPHOBLASTIC-LEUKEMIA REGIMENS IN B-CELL L(3) ACUTE-LEUKEMIA AND ADVANCED-STAGE BURKITTS-LYMPHOMA/

Background. Adult B/L(3)-ALL is a rare disease subset characterized by an aggressive clinical course and a poor response to conventional adu lt ALL-type chemotherapy. Recent data from the GMALL Group showed that prognosis can be improved with an innovative treatment regimen. In th e current retrospective survey we focus on therapeutic results obtaine d at our Institutions during a 15-year period with ALL-type regimens i n 34 adults with either B/L(3)-ALL or advanced-stage Burkitt's lymphom a. Methods. Five successive ALL treatment programs were developed. The y included a homogeneous induction phase with early intrathecal chemop rophylaxis, multidrug postremission consolidation followed by cranial irradiation (4 trials), high-dose chemotherapy plus autografting (2 tr ials), late consolidation (2 trials), and variable-length maintenance (4 trials). Early response and prolonged disease-free survival rates w ere analyzed according to selected clinical and therapeutic variables. Results. Overall, a complete remission was achieved in 62%, with a me dian duration of 1.6 years and a 10-year remission rate of 49%. A diag nosis of B/L(3)-ALL (p=0.007), the use of idarubicin instead of adriam ycin during induction (p=0.018), a serum creatinine <1.6 mg/dL, and an uninvolved central nervous system were associated with higher respons e rates. As regards long-term disease-free survival, results were sign ificantly better in patients with <1 x 10(9)/L L(3)/blast cells in the peripheral blood (p=0.0029) and/or aged <50 years (p=0.04), and in th ose consolidated with the most recent rotational high-dose plus periph eral blood stem cell autotransplant regimen. Conclusions. According to the results presented, ALL-Like regimens may still represent a worthw hile therapeutic choice. The use of idarubicin during induction, the p rognostic subclassification of patients, a careful control of dysmetab olic complications, the selection of the proper chemo-radioprevention for meningeal disease and perhaps the introduction of high-dose chemot herapy supported by autologous stem cell rescue appear to be the mains tay of further improvements.