LONG-TERM FOLLOW-UP OF TREATMENT AND POTENTIAL CURE OF ADULT ACUTE LYMPHOCYTIC-LEUKEMIA WITH MOAD - A NON-ANTHRACYCLINE CONTAINING REGIMEN

A total of 55 previously untreated adults with acute lymphocytic leuke mia (ALL), median age 38 years (range 15-73 years), were treated with MOAD (methotrexate, vincristine, L-asparaginase, and dexamethasone). T his regimen includes five phases - induction, consolidation, cytoreduc tion, maintenance, and central nervous system (CNS) prophylaxis with p arenteral high-dose methotrexate. Of the 55 evaluable patients, 42 ach ieved complete remission (76 %), with a median CR duration of 12 + mon ths (range 0.5-195 + months). The median survival in remission is 22 months (range 1-198+ months), with 33% of remitters continuing in lon g-term remissions (>5 years). Two out of four patients who developed C NS leukemia did so without marrow relapse, were sucessfully treated fo r that complication, and continue in total complete remission at 8+ an d 16+ years. Another patient with extramedullary relapse (breast) was treated with radiation to that site and remains in total CR at 16 + ye ars. Expected toxicities included myelosuppression during the inductio n phase of treatment, with 65% of patients requiring intravenous antib iotics. Mucositis was the next most frequent toxicity and required dos e-reduction in seven patients. Minimal toxicity was seen during the po st-remission phases of treatment. L-Asparaginase toxicity was more pro minent during intravenous administration (24 patients) than when the i ntramuscular route of administration (30 patients) was used. The remis sion rale and long-term survivorship achieved with this regimen, witho ut the use of an anthracycline, is comparable to that of other regimen s for adult ALL. MOAD was well-tolerated by young and old adults with ALL. Aseptic necrosis of bone, successfully treated in each instance, occurred in four long-term disease-free survivors. The effect of this complication and its treatment on quality of life has been negligible.