Salvage Therapy for Resistant or Relapsing Acute Lymphoblastic Leukemia (ALL) after Idarubicin-Based Induction View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2003

AUTHORS

E. Di Bona , R. Sartori , T. Lerede , G. Rossi , M. Vespignani , F. Rodeghiero , T. Barbui , R. Bassan

ABSTRACT

Idarubicin-based induction programs in acute lymphoblastic leukemia (ALL) account for 75%–85% of complete remission rate. A small amount of patients exhibit primary refractoriness, and about 60% of those achieving a remission eventually relapse. This study was aimed to review the clinical response to retreatment in ALL patients relapsing after or resistant to idarubicin-based induction. The “ABC” second-line regimen, consisted of a combination of high-dose methotrexate, methyl-prednisolone, vincristine and mitoxantrone. Twenty-eight patients (3 primary resistant, 25 at first relapse) were treated with two courses (“A” and “B”, the latter with reduced drug dosages) for remission (re)induction and early consolidation. Autologous or allogeneic bone marrow transplantation was then planned (“C”), depending on the availability of related/unrelated HLA-compatible donors. With cycle “A”, 68% of the patients (2/3 resistant and 17/25 relapsed) achieved a response; 4 were refractory (14%) and 5 (18%) died early. 58% of 19 responsive patients received course “B”, 2 underwent allogeneic BMT (1 refractory), one had an autograft, and 5 did not receive any further treatment. After course 2, 7/11 patients received course “C” (4 auto, 3 allo hematopoietic stem cell transplant). WHO grade 3-4 treatment-related toxicity, mostly gastroenteric (41%), developed in 50% and 25% of the cases during course „A“, and 36% of the cases during course „B“ (grade 3). The median duration of complete response was 118 days (18–327); overall survival from date of relapse/refractoriness was 187 days (15–530). Only two patients are alive in remission at 120+ and 170+ days, and 3 died in remission of toxic complications. The “ABC” salvage therapy was feasible and effective for induction of remission after Idarubicin-based programs. The short duration of the response so achieved raises the question of the best post-induction treatment. More... »

PAGES

461-464

Book

TITLE

Acute Leukemias IX

ISBN

978-3-642-63949-4
978-3-642-59358-1

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-642-59358-1_77

DOI

http://dx.doi.org/10.1007/978-3-642-59358-1_77

DIMENSIONS

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