IMPROVED OUTCOME OF ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA BY MODERATELY INTENSIFIED CHEMOTHERAPY WHICH INCLUDES A PREINDUCTION COURSE FOR RAPID TUMOR REDUCTION - PRELIMINARY-RESULTS ON 66 PATIENTS

Sixty-six consecutive adult patients with acute lymphoblastic leukaemi a (ALL) were treated with intensified chemotherapy which included a 'p re-induction' course of cytarabine (AraC) and etoposide (VP16) when th e white blood cell count (WBC) was greater than or equal to 30x10(9)/l (18 patients), and maintenance chemotherapy with regular intensificat ions for a total treatment duration of 3 years. Patients with a medias tinal mass (17) received consolidation courses with intermediate-dose AraC and VP16 followed by mediastinal irradiation. 11 patients underwe nt allogeneic bone marrow transplantation in first complete remission (CR). 58 patients (87.9%, CI 77.5-94.6) attained CR; with a median fol lowup of 7 years, 35 of them (60.3%, CI 46.6-73.0) remain in CR. Toxic ity was mild, although three patients died during remission induction, including two who were over 70 years of age. 23 patients (39.7%, CI 2 7.1-53.4) relapsed, seven of them primarily in the central nervous sys tem (CNS), necessitating intensification of CNS-directed therapy. Only one of 13 patients with WBC 30-100x10(9)/l, but eight of nine with WB C >100x10(9)/l, relapsed. The survival of older patients in CR did not differ from younger patients. The outcome of ALL in adult patients co uld thus be improved by slight intensification of treatment whilst kee ping the toxicity within acceptable limits. 'Pre-induction' with AraC and VP16 might improve the prognosis, especially in patients with WBC <100x10(9)/l. Patients with WBC >100x10(9)/l, however almost always re lapse, and the intensified chemotherapy might not be tolerated well by patients over 70 years of age.