Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: results from the international ALL trial MRC UKALL XII/ECOG E2993.
AuthorsLazarus, Hillard M
Richards, Susan M
Litzow, Mark R
Burnett, Alan K
Wiernik, Peter H
Franklin, Ian M
Tallman, Martin S
Durrant, I Jill
Rowe, Jacob M
Goldstone, Anthony H
AffiliationComprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA. firstname.lastname@example.org
MetadataShow full item record
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.
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 Blood
- [Treatment of acute lymphoblastic leukemia in adults with seven-drug induction therapy and intensive consolidation with or without autologous stem cell transplantation followed by maintenance therapy. Experience of a single center].
- Authors: Doubek M, Mayer J, Korístek Z, Protivánková M, Brychtová Y, Oborilová A, Král Z, Klabusay M, Tomíska M, Buchtová I, Vorlícek J
- Issue date: 2002 Mar 1
- Long-term remission of Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation from matched sibling donors: a 20-year experience with the fractionated total body irradiation-etoposide regimen.
- Authors: Laport GG, Alvarnas JC, Palmer JM, Snyder DS, Slovak ML, Cherry AM, Wong RM, Negrin RS, Blume KG, Forman SJ
- Issue date: 2008 Aug 1
- In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993).
- Authors: Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, Burnett AK, Chopra R, Wiernik PH, Foroni L, Paietta E, Litzow MR, Marks DI, Durrant J, McMillan A, Franklin IM, Luger S, Ciobanu N, Rowe JM
- Issue date: 2008 Feb 15
- Allogeneic stem cell transplantation for adult patients with acute lymphoblastic leukemia who had central nervous system involvement: a study from the Adult ALL Working Group of the Japan Society for Hematopoietic Cell Transplantation.
- Authors: Shigematsu A, Kako S, Mitsuhashi K, Iwato K, Uchida N, Kanda Y, Fukuda T, Sawa M, Senoo Y, Ogawa H, Miyamura K, Takada S, Nagamura-Inoue T, Morishima Y, Ichinohe T, Atsuta Y, Mizuta S, Tanaka J
- Issue date: 2017 Jun
- Central nervous system relapse in adults with acute lymphoblastic leukemia after allogeneic hematopoietic stem cell transplantation.
- Authors: Hamdi A, Mawad R, Bassett R, di Stasi A, Ferro R, Afrough A, Ram R, Dabaja B, Rondon G, Champlin R, Sandmaier BM, Doney K, Bar M, Kebriaei P
- Issue date: 2014 Nov