Terapie akutní lymfoblastické leukémie dosplých kombinací sedmi chemoterapeutik v indukční léšbě, intenzivní konzolidací s autologní transplatací kmenových buněk krvetvorby nebo bez ní a s následnou udržovací léčbou: zkušenosti jednoho centr

A Seven-Drug Induction Regimen with Intensive Consolidation and without Autologous Peripherial Blood Stem Cell Transplantation Followed by Maintenance Chemotherapy for Acute Lymphoblastic Leukaemia in Adults: A Single Centre Experience

Background.
During the last few years, improvement in prognosis of the adult acute lymphoblastic leukaemia (ALL) has been modest. The probability of leukemia-free survival is 20-40 %. Philadelphia-chromosome positive (BCR-ABL positive) ALL has the worse prognosis. A Single centre experience with treatment of ALL in adults is reported.Methods and Results. Between Apríl 1997 and July 2000, 15 consecutive patients with de novo adult ALL (7 T-lineage ALL, 7 B-lineage ALL,1 null ALL) begin their treatment with the Seven-drug induction regimen (in phase I, daunorubicin, vincristine, L-asparaginase, IV, and prednisone, PO; in phase II, 6-mercaptopurine, PO, cytosine arabinoside and cyclophosphamide, IV) and central nervous system (CNS) prophylaxis (methotrexate and CNS irradiation in patients without total body irradiation in conditioning regimen), with intensive consolidation (three times high-dose methotrexat and high-dose-cytarabine, IV), and with/out autologous peripheral blond stem cell transplantation (PBSCT) followed by maintenance chemotherapy (6-mercaptopurine and metotrexate, PO). Seven patients received autologous PBSCT. Methan patient age was 30 years. Three patients were BCR-ABL positive at diagnosis. With methan follow-up 14 month (range 0,1-46 month), Seven (4 T-lineage ALL, 2 B-lineage ALL, 1 null ALL) out of 15 patients are alive in remission (four of them receiving autologous PBSCT). Causes of death were relapse (n=3), chemotherapy related toxicity (n=2), infection (n=1), and acute myeloid leukaemia developed 10 months after autologous PBSCT (n=1). All BCR-ABL positive patients died.Conclusions. Chemotherapy alone and autologous PBSCT with maintenance therapy may be curative for adult patients with ALL. We can recommend these treatment options for patients without risk factors in particular.

Key words:
acute lymphoblastic leukaemia, autologous peripheral blond stem cell transplantation, maintenance therapy.