RELATIONSHIP BETWEEN DAUNORUBICIN DOSAGE DELIVERED DURING INDUCTION THERAPY AND OUTCOME IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA

The long-term results of a therapeutic regimen for adult acute lymphob lastic leukemia (ALL) have been analysed with the main purpose to eval uate the impactof Daunorubicin (DNM) dosage given during the induction . The files of 86 consecutive adult ALL patients treated in our instit ution between 1974 and 1988 were reviewed. They received the same indu ction regimen based on Vincristine, DNM and Prednisone, consolidation with L-Asparaginase, central nervous system prophylaxis, and 3-year ma intenance with B-mercaptopurine and Methotrexate with periodic cycles of reinduction. We analysed the overall and disease-free survival (DFS ) in relation to various prognostic factors, focusing on the dosage of DNM actually received during the induction period. Complete remission (CR) was achieved in 68 (79%) patients and the overall DFS was of 32 m onths (median follow-up 37 months); 22 patients (25.6%) are off-therap y and disease-free. Theactual dosage of DNM received during induction turned out to be an independent DFS prognostic factor. In fact, patien ts who received more or less than 175 mg/sqm in induction had a median DFS of 44 and 12 months, respectively (p = 0.05). The plateau of DFS in the two groups was 44% and 21%, respectively. Similar data were fou nd analyzing the dose-intensity (mg/sqm/week) of DNM given in inductio n. Our data suggest that the actual dosage of DNM given in induction p lays a role in the long term DFS of adult ALL.