Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993.

2.50
Hdl Handle:
http://hdl.handle.net/10541/72547
Title:
Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993.
Authors:
Lazarus, Hillard M; Richards, Susan M; Chopra, Rajesh; Litzow, Mark R; Burnett, Alan K; Wiernik, Peter H; Franklin, Ian M; Tallman, Martin S; Cook, Lucy; Buck, Georgina; Durrant, I Jill; Rowe, Jacob M; Goldstone, Anthony H
Abstract:
Outcome of acute lymphoblastic leukemia (ALL) in adults with central nervous system (CNS) disease at diagnosis is unclear. We treated 1508 de novo ALL patients with 2-phase induction and then high-dose methotrexate with l-asparaginase. Patients up to 50 years old in first remission (CR1) with a matched related donor (MRD) underwent an allogeneic stem cell transplantation (SCT); the remainder in CR1 were randomized to an autologous SCT or intensive consolidation followed by maintenance chemotherapy. Philadelphia chromosome (Ph)-positive patients were offered a matched unrelated donor (MUD) allogeneic SCT. Seventy-seven of 1508 (5%) patients a median age of 29 years had CNS leukemia at presentation; 13 of the 77 (17%) had Ph-positive ALL. Sixty-nine of 77 (90%) patients attained CR1. Thirty-six patients underwent transplantation in CR1 (25 MRD, 5 MUD, and 6 autografts). Eleven of 25 patients with MRD transplantation remain alive at 21 to 102 months, 2 of 5 with MUD at 42 and 71 months, and 1 of 6 with autologous SCT at 35 months. Seven of 27 treated with consolidation/maintenance remain in CR1 56 to 137 months after diagnosis. Overall survival at 5 years was 29% in those with CNS involvement at diagnosis versus 38% (P = .03) for those without. CNS leukemia in adult ALL is uncommon at diagnosis. Adult Ph-negative ALL patients, however, can attain long-term disease-free survival using SCT as well as conventional chemotherapy.
Affiliation:
Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. hillard.lazarus@case.edu
Citation:
Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993. 2006, 108 (2):465-72 Blood
Journal:
Blood
Issue Date:
15-Jul-2006
URI:
http://hdl.handle.net/10541/72547
DOI:
10.1182/blood-2005-11-4666
PubMed ID:
16556888
Type:
Article
Language:
en
ISSN:
0006-4971
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorLazarus, Hillard M-
dc.contributor.authorRichards, Susan M-
dc.contributor.authorChopra, Rajesh-
dc.contributor.authorLitzow, Mark R-
dc.contributor.authorBurnett, Alan K-
dc.contributor.authorWiernik, Peter H-
dc.contributor.authorFranklin, Ian M-
dc.contributor.authorTallman, Martin S-
dc.contributor.authorCook, Lucy-
dc.contributor.authorBuck, Georgina-
dc.contributor.authorDurrant, I Jill-
dc.contributor.authorRowe, Jacob M-
dc.contributor.authorGoldstone, Anthony H-
dc.date.accessioned2009-07-06T10:54:18Z-
dc.date.available2009-07-06T10:54:18Z-
dc.date.issued2006-07-15-
dc.identifier.citationCentral nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993. 2006, 108 (2):465-72 Blooden
dc.identifier.issn0006-4971-
dc.identifier.pmid16556888-
dc.identifier.doi10.1182/blood-2005-11-4666-
dc.identifier.urihttp://hdl.handle.net/10541/72547-
dc.description.abstractOutcome of acute lymphoblastic leukemia (ALL) in adults with central nervous system (CNS) disease at diagnosis is unclear. We treated 1508 de novo ALL patients with 2-phase induction and then high-dose methotrexate with l-asparaginase. Patients up to 50 years old in first remission (CR1) with a matched related donor (MRD) underwent an allogeneic stem cell transplantation (SCT); the remainder in CR1 were randomized to an autologous SCT or intensive consolidation followed by maintenance chemotherapy. Philadelphia chromosome (Ph)-positive patients were offered a matched unrelated donor (MUD) allogeneic SCT. Seventy-seven of 1508 (5%) patients a median age of 29 years had CNS leukemia at presentation; 13 of the 77 (17%) had Ph-positive ALL. Sixty-nine of 77 (90%) patients attained CR1. Thirty-six patients underwent transplantation in CR1 (25 MRD, 5 MUD, and 6 autografts). Eleven of 25 patients with MRD transplantation remain alive at 21 to 102 months, 2 of 5 with MUD at 42 and 71 months, and 1 of 6 with autologous SCT at 35 months. Seven of 27 treated with consolidation/maintenance remain in CR1 56 to 137 months after diagnosis. Overall survival at 5 years was 29% in those with CNS involvement at diagnosis versus 38% (P = .03) for those without. CNS leukemia in adult ALL is uncommon at diagnosis. Adult Ph-negative ALL patients, however, can attain long-term disease-free survival using SCT as well as conventional chemotherapy.en
dc.language.isoenen
dc.subjectHaematopoietic Stem Cell Transplantationen
dc.subjectCentral Nervous System Canceren
dc.subjectLeukaemia Lymphomaen
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAsparaginase-
dc.subject.meshCentral Nervous System Neoplasms-
dc.subject.meshFemale-
dc.subject.meshHematopoietic Stem Cell Transplantation-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMethotrexate-
dc.subject.meshMiddle Aged-
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphoma-
dc.subject.meshRemission Induction-
dc.subject.meshSurvival Rate-
dc.titleCentral nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993.en
dc.typeArticleen
dc.contributor.departmentComprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. hillard.lazarus@case.eduen
dc.identifier.journalBlooden

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