Long-term follow-up results of adult patients with acute lymphocytic leukemia or lymphoblastic lymphoma treated with short-term, alternating non-cross-resistant chemotherapy: Japan Clinical Oncology Group Study 8702

Background: Patients with acute lymphocytic leukemia (PILL) and those with lymphoblastic lymphoma (LBL) have overlapping clinical and immunophenotypic features and they have been treated with the same or very similar chemothe rapy regimens. The goal of this multi-institutional phase II trial waste ev aluate the therapeutic efficacy of a short-term, six-drug chemotherapy regi men for adult patients with untreated ALL or LBL. Methods: Forty-six eligible patients, 41 with ALL and five with LBL, were t reated with a short-term (planned total therapy duration; 36-38 weeks), sim plified chemotherapy program; two courses of VEPA-L (vincristine, cyclophos phamide, prednisolone, doxorubicin, I-asparaginase plus intrathecal methotr exate and prednisolone) followed by four courses of M-VEPA (methotrexate pl us VEPA), without the traditional maintenance therapy using daily 6-mercapt opurine and weekly methotrexate. Results: Thirty-six (78%; 95% confidence interval 64-89%) of the 46 eligibl e patients achieved complete remission (CR). Among the 36 patients who achi eved CR, four (11%) died of treatment complications, 26 (72%) relapsed and six (17%) remain alive in continuous CR. The median survival for all 46 eli gible patients is 14 months and the median disease-free survival (DFS) for the 36 patients who achieved CR is II months. The estimate of the proportio n of survival at 7 years of all 46 eligible patients is 15% at-a median fol low-up time of 96 months and that of DFS of the. 36 patients achieving CR i s 17% at a median follow-up time of 93 months. Subgroup analysis showed tha t an elevated serum C-reactive protein (CRP) level, age of 30 years or olde r, the. presence of B-symptom and T-cell phenotype were likely to be associ ated with shortened survival. Although the observed CR rate (78%) is within the range of satisfaction, the long-term survival rate (15%) is inferior t o those of published programs incorporating maintenance therapy. Conclusions: A fraction of-adult patients with ALL or LBL are curable with a short-term, six-drug chemotherapy regimen. However, this simplified thera py of shorter duration cannot be recommended.