HIGH-DOSE ARA-C FOR REMISSION INDUCTION AND CONSOLIDATION OF PREVIOUSLY UNTREATED ADULTS WITH ALL OR LYMPHOBLASTIC LYMPHOMA

Thirty-two patients with untreated ALL (n = 26) or lymphoblastic lymph oma (n = 6) between 17 and 65 years of age were treated with a short r emission induction course with VP16-213, amsacrine, intermediate dose Ara-C for 6 days, prednisone and intrathecal methotrexate, followed by a consolidation course with vincristine, amsacrine, high dose Ara-C f or 4 days, prednisone and intrathecal methotrexate. After subsequent c ranial irradiation, no further maintenance was planned. However, some patients underwent an allogeneic (n = 5) or autologous (n = 5) bone ma rrow transplantation after the consolidation treatment. Twenty-three o f 32 patients (72%) achieved a complete remission. Ten of 13 patients with T-ALL or lymphoma, six of eight patients with pre-B or common ALL , and seven of 11 patients with B-ALL or Burkitt's lymphoma achieved a complete remission. The median duration of remission was 24 months. O verall survival for the whole group was 35% at 5 years. The disease-fr ee survival was 45% at 5 years. Long-term survival for patients with B or T-ALL was approximately 60%, compared with 15% for those with comm on or pre B-ALL. Short term intensive courses including intermediate o r high dose Ara-C during remission and consolidation treatment lead to results comparable to those obtained with long-term maintenance regim ens. Our regimen may be sufficient for patients with T or B-ALL. Large r randomized studies are needed to investigate the relative importance of our observations.