Analysis of 20-year follow-up study of LVP regimen for adult acute lymphoblastic leukemia

In an attempt to develop a new intensive chemotherapy for adults with untre ated acute lymphoblastic leukemia (ALL), 3 sequential programs were designe d for 62 patients (age range, 15 to 74 years; median age, 32 years) consist ing of the LVP-79 (1979-1984,27 patients), LVP-85 (1984-1986,14 patients), and LVP-87 (1987-1989, 21 patients) regimens. The influence of clinical and biologic characteristics on the patient outcome was also examined. L-aspar aginase (L-asp) vincristine, and prednisolone, defined collectively as LVP, were administered for induction chemotherapy in all protocols. After achie ving complete remission (CR), patients underwent 2 years of multi-agent con solidation, intensification, and maintenance therapy consisting of various combinations. No significant differences were noted between the 3 groups re garding CR rate or survival. In total, 47 of 62 patients (75.8 %) achieved CR. The median overall survival (OS) and median CR durations were 550 days and 341 days, respectively. Overall, the estimated survival rate at 20 year s was 18.1 %. The disease-free survival rate at 20 years was 26.2 %. Accord ing to univariate analysis, the most favorable pretreatment characteristic for achieving CR was age. A younger age (< 40 years of age), platelet count > 30 x 10(9)/L, having L1 morphology (French-American-British [FAB]classif ication subtype), female sex, and the absence of chromosomal abnormalities also helped improve survival rate. According to multivariate analysis, pres ence of Ph chromosome was found to be a major influencing factor for OS. Al though higher doses of L-asp were administered than those used in previous studies, the adverse effect of L-asp was rarely identified. Therefore, it s hould be considered one of the key drugs for treatment of adult ALL. Furthe r strategies still need to be developed to obtain better survival in adult ALL. (C) 2001 The Japanese Society of Hematology.