ESTIMATED 6-YEAR EVENT-FREE SURVIVAL OF 55-PERCENT IN 60 CONSECUTIVE ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA PATIENTS TREATED WITH AN INTENSIVE PHASE-II PROTOCOL BASED ON HIGH INDUCTION DOSE OF DAUNORUBICIN

On the basis of a previous experience suggesting that daunorubicin dos e in induction was an independent prognostic factor in adult ALL, we d esigned a chemotherapeutic regimen (ALLVR589) characterized by high do ses of daunorubicin (270 mg/m(2)) in induction and by high-dose Ara-C in post-remission. The protocol was otherwise conventional: induction and past-remission therapy were followed by chemo-radio prophylaxis of the central nervous system (CNS) and periodical reinductions over a 3 -year maintenance period. Sixty consecutive patients (male 42, female 18, median age 34 years, range 14-71; B-lineage, 35; T-lineage, 25; Ph and bcr/abl positive, 7) recruited between 1989 and 1996, were evalua ted for treatment outcome, Complete remissions were 56 (93%), one pati ent had refractory disease, early deaths were five (8%); 19/56 (34%) p atients relapsed, five of wham were Ph+, Median time to relapse was II months (range 3-47); 68% of relapses occurred within 12 months from C R. No CNS relapses were observed, After a median follow-up of 44 month s (1-100), 33/60 (55%) patients remain event-free; 23/60 (38%) are off -therapy in continuous CR (median follow-up from diagnosis: 63 months; range 38-100), These results suggest that increasing DNM dosage in in duction is one of the possible approaches to improve the outcome of ad ult ALL by decreasing the relapse occurrence.