INTENSIVE POSTREMISSION CHEMOTHERAPY WITHOUT MAINTENANCE THERAPY IN ADULTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

Purpose: To investigate the value of intensive consolidation chemother apy not followed by maintenance therapy in adult acute lymphoblastic l eukemia (ALL). Materials and Methods: A multicenter phase II trial was conducted in 130 adult patients with ALL between 16 and 60 years of a ge. After standard induction therapy, postinduction chemotherapy was g iven: three courses of high-dose cytarabine (2,000 mg/m(2) every 12 ho urs for four doses) in combination with amsacrine (course one), mitoxa ntrone (course two), and etoposide (course three). CNS prophylaxis con sisted of 10 injections of intrathecal methotrexate (IT MTX). Patients younger than 50 years with an HLA-identical sibling were eligible to receive allogeneic bone marrow transplantation (BMT). Results: Ninety- five patients (73%) achieved complete remission (CR); 82% were younger than 50 years and 41% were older than 50 years. Seventeen patients (1 3%) were resistant to chemotherapy, and 18 (14%) died during induction treatment. Only age and performance status were significantly associa ted with response < .001 and .03, respectively). Death during consolid ation occurred in four patients. The estimated 5-year overall survival (OS) was 22% for the entire group and 26% for patients younger than 3 5 years. Disease-free survival (DFS) at 5 years was 28% +/- 6 for pati ents younger than 35 years, 25% +/- 9 far patients between 35 and 50 y ears, and 0% for patients older than 50 years. Increasing age (P < .01 ) and expression of CD34 (P < .01) were adverse factors. Only three pa tients (3%) developed an isolated CNS relapse. Conclusion: Intensive c onsolidation including high-dose cytarabine nor followed by maintenanc e therapy provides an outcome for adult patients with ALL that may be worse or even inferior compared with studies using long-term maintenan ce therapy. High-dose cytarabine in combination with IT MTX was effect ive for CNS prophylaxis. (C) 1997 by American Society of Clinical Onco logy.