ESTIMATED 8-YEAR SURVIVAL OF MORE THAN 40-PERCENT IN A POPULATION-BASED STUDY OF 79 ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

We report II years experience with a modified version of a chemotherap y programme in use at the MRC Leukaemia Unit from 1982 to 1984, supple mented by allogeneic bone marrow transplantation in first relapse or s econd or later remission from 1985. 79 consecutive patients aged 15-60 years with newly diagnosed acute lymphoblastic leukaemia (ALL) were g iven induction chemotherapy. This included a standard DAT course (daun orubicin, cytarabine and thioguanine) applied as in acute myelogenous leukaemia approximately midway in the induction programme. A 3-year ro tating maintenance programme consisted of combinations of cytotoxic dr ugs used in the induction therapy. CNS prophylaxis did not include CNS irradiation. Allogeneic BMT was not performed in first remission. The overall complete remission (CR) rate was 82% (65/79). 26 patients rel apsed (seven first in the CNS). Seven patients underwent allogeneic BM T of whom six are alive and well with a mean observation time of 32 mo nths (range 4-99 months) after transplantation. Three patients died in first CR. Estimated 5- and 8-year overall survival was 51% (95% confi dence interval (CI) 39-63) and 47% (CI 33-61). For patients who reache d CR, the corresponding figures were 63% (CI 50-76) and 57% (CI 41-73) . Estimated disease-free survival in the remitters was 54% (CI 40-68) at 5 years and 44% (CI 28-60) at 8 years. Patient age below 25 years a nd white cell count below 15 x 10(9)/l at presentation were both found to improve the chance of overall survival.