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


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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).

References

  1. Gee T. S., Haghbin M., Dowling M. D. et al. Acute lymphoblastic leukemia in adults and children. Differences in response with similar therapeutic regimens. Cancer (Philad.) 1976; 37 (3): 1256-1264.
  2. Hoelzer D., Gokbuget N., Ottmann O. et al. Acute lymphoblastic leukemia. In: Hematology. ASH. Education program book 2002. 162-192.
  3. Nachmann S., Sather H. N., Buckley J. D. et al. Young adults 16-21 years of age at diagnosis entered on Children's Cancer Group acute lymphoblastic leukemia and acute myeloblastic leukemia protocols. Results of treatment. Cancer 1993; 71: 3377-3384.
  4. Shiffer C. A. Differences in outcome in adolescence and young adults with ALL: a consequence of better regimens? Better doctors? Both? J. Clin. Oncol. 2003; 21: 760-767.
  5. Stock W., La M., Sanford B. et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children's Cancer Group and Leukemia Group B studies. Blood 2008; 112: 1646-1654.
  6. Boissel N., Auclerc M. F., Lheritier V. et al. Should adolescents witn acute lymphoblastic leukemia be treated as old children or young adults? Comparison of French FRALLE-93 and LALA-94 trials. J. Clin. Oncol. 2003; 21: 774-780.
  7. de Bont J. M., Holt B., Dekker A. W. et al. Significant difference in outcome for adolescents with acute lymphoblastic leukemia treated on pediatric versus adult protocols in the Netherlands. Leukemia 2004; 18: 2032-2035.
  8. Ramanujachar R., Richards S., Harm I. et al. Adolescents with acute lymphoblastic leukaemia: outcome on UK national paediatric (ALL97) and adult (UKALLXII/E2993) trials. Pediatr. Blood Cancer 2007; 48: 254-261.
  9. Testi A., Valsecchi M., Conter V. et al. Difference in outcome of adolescents with acute lymphoblastic leukemia (ALL) enrolled in pediatric (AIEOP) and adult (GIMEMA) protocols. Blood 2004; 104 (11): abstr. 539a.
  10. Hallbook H., Gustafsson G., Smedmyr B. et al. Treatment outcome in young adults and children > 10 years of age with acute lymphoblastic leukemia in Sweden: comparison between a pediatric protocol and an adult protocol. Cancer 2006; 107: 1551-1561.
  11. DeAngelo D. J. The treatment of adolescence and young adults with ALL. Jn: Hematology, ASH. Education program book. 2005; (1): 123-130.
  12. Савченко В. Г., Паровичникова Е. Н., Исаев В. Г. и др. Лечение острых лимфобластных лейкозов взрослых как нерешенная проблема. Тер. арх. 2001; 7: 6-15.
  13. Давидян Ю. Р., Сурин В. Л., Паровичникова Е. Н., Савченко В. Г. Динамическое исследование реаранжировки генов иммуноглобулинов и Т-клеточных рецепторов при острых лимфобластных лейкозах. Гематол. и трансфузиол. 2006; 2: 3-10.
  14. Давидян Ю. Р. Детекция и мониторинг специфической реаранжировки генов иммуноглобулинов в процессе лечения острых лимфобластных лейкозов. Дис. канд. мед. наук. М.; 2007.
  15. Савченко В. Г., Паровичникова Е. Н., Давидян Ю. Р., Исаев В. Г. Острые лимфобластные лейкозы. ВКН. Программное лечение лейкозов М., 2008: 182-263.
  16. Schrappe M., Reiter A., Ludwig W. D. et al. Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. Blood 2000; 95: 3310-3322.
  17. Annino L., Vegna M. L., Camera A. et al. Treatment of adult acute lymphoblastic leukemia (ALL): long-term follow-up of the GIMEMA ALL 0288 randomized study. Blood 2002; 99: 863-871.
  18. Siebel N. L., Shteinherz R., Sather H. et al. Early treatment intensification improves outcome in children and adolescence with ALL presenting with unfavorable features who show a rapid early response to induction chemotherapy: a report of CCG 1961. Blood 2003; 102 (11) abstr. 787.

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