Results of the treatment of adult acute lymphoblastic leukemia according to ALL-2005 protocol as a basis for new trials

Abstract

Aim. To analyse the results of the treatment according to ALL-2005 protocol for adult patients with acute lymphoblastic leukemia (ALL); on the basis of the summarized evidence on ALL treatment to propose principles for development of a new program of ALL treatment in 15-55-year-old patients.
Material and methods. Five hematological centers (in Moscow, Saransk, Volgograd, Tambov, Kirov) participated in ALL-2005 protocol trial initiated in 2005. A total of 71 adult patients with ALL (age median 27 years) were treated. The results of the MB-2002 study with participation of 16 patients aged 16-23 years performed in the State Hematological Research Center (SHRC) were reviewed.
Results. The results of the induction therapy according to ALL-2005 protocol conducted in Moscow SHRC were good: a complete remission was achieved in 90% patients, early lethality was 6%, resistance was observed in 4%. In regional centers lethality in remission was higher, 5-year overall survival was 28% (in SHRC it was 56%), recurrence-free survival in regional center was 22% versus 51%, respectively. Long-term response by ALL-2005 and MB-2002 in patients aged 19-23 was the same, but toxicity of ALL-2005 treatment was higher (no lethality and 5, 4% in induction and remission, respectively).
Conclusion. The decision was made on design of a new protocol of treatment of Ph-negative ALL for patients aged from 15 to 55 years the main principles of which are the following: continuous treatment with modification of cytostatic drugs doses depending on myelosuppression severity; assessment of tumor cells sensitivity to prednisolone and its replacement for dexametasone throughout the treatment; prolongation of L-asparaginase treatment with elevation of its total dose; monitoring of minimal residual disease (MRD) for decision on late intensification in patients with MRD at late treatment stages (5 months).

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Copyright (c) 2009 Parovichnikova E.N., Davidyan Y.R., Isaev V.G., Sokolov A.N., Klyasova G.A., Mendeleeva L.P., Lyubimova L.S., Ustinova E.N., Gribanova E.O., Mavrina E.S., Kulikov S.M., Kaplanov K.D., Zagoskina T.P., Sviridova E.I., Gavrilova L.V., Savchenko V.G., Parovichnikova E.N., Davidyan Y.R., Isaev V.G., Sokolov A.N., Klyasova G.A., Mendeleeva L.P., Lyubimova L.S., Ustinova E.N., Gribanova E.O., Mavrina E.S., Kulikov S.M., Kaplanov K.D., Zagoskina T.P., Sviridova E.I., Gavrilova L.V., Savchenko V.G.

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