BACKGROUND: About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia. DESIGN AND METHODS: We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials. RESULTS: The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%). CONCLUSIONS: The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.
BACKGROUND: About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia. DESIGN AND METHODS: We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials. RESULTS: The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%). CONCLUSIONS: The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.
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Authors: Luciana Annino; Maria Luce Vegna; Andrea Camera; Giorgina Specchia; Giuseppe Visani; Giuseppe Fioritoni; Felicetto Ferrara; Antonio Peta; Stefania Ciolli; Wilma Deplano; Francesco Fabbiano; Simona Sica; Francesco Di Raimondo; Nicola Cascavilla; Antonio Tabilio; Pietro Leoni; Rosangela Invernizzi; Michele Baccarani; Bruno Rotoli; Sergio Amadori; Franco Mandelli Journal: Blood Date: 2002-02-01 Impact factor: 22.113
Authors: Deborah A Thomas; Stefan Faderl; Jorge Cortes; Susan O'Brien; Francis J Giles; Steven M Kornblau; Guillermo Garcia-Manero; Michael J Keating; Michael Andreeff; Sima Jeha; Miloslav Beran; Srdan Verstovsek; Sherry Pierce; Laurie Letvak; August Salvado; Richard Champlin; Moshe Talpaz; Hagop Kantarjian Journal: Blood Date: 2003-10-09 Impact factor: 22.113
Authors: R A Larson; R K Dodge; C P Burns; E J Lee; R M Stone; P Schulman; D Duggan; F R Davey; R E Sobol; S R Frankel Journal: Blood Date: 1995-04-15 Impact factor: 22.113
Authors: J Takeuchi; T Kyo; K Naito; H Sao; M Takahashi; S Miyawaki; K Kuriyama; S Ohtake; F Yagasaki; H Murakami; N Asou; T Ino; T Okamoto; N Usui; M Nishimura; K Shinagawa; T Fukushima; H Taguchi; T Morii; S Mizuta; H Akiyama; Y Nakamura; T Ohshima; R Ohno Journal: Leukemia Date: 2002-07 Impact factor: 11.528
Authors: Anthony S Stein; Richard A Larson; Andre C Schuh; William Stevenson; Ewa Lech-Maranda; Qui Tran; Zachary Zimmerman; William Kormany; Max S Topp Journal: Blood Adv Date: 2018-07-10
Authors: William H Gmeiner; Waldemar Debinski; Carol Milligan; David Caudell; Timothy S Pardee Journal: Future Oncol Date: 2016-06-09 Impact factor: 3.404
Authors: Hagop Kantarjian; Anthony Stein; Nicola Gökbuget; Adele K Fielding; Andre C Schuh; Josep-Maria Ribera; Andrew Wei; Hervé Dombret; Robin Foà; Renato Bassan; Önder Arslan; Miguel A Sanz; Julie Bergeron; Fatih Demirkan; Ewa Lech-Maranda; Alessandro Rambaldi; Xavier Thomas; Heinz-August Horst; Monika Brüggemann; Wolfram Klapper; Brent L Wood; Alex Fleishman; Dirk Nagorsen; Christopher Holland; Zachary Zimmerman; Max S Topp Journal: N Engl J Med Date: 2017-03-02 Impact factor: 91.245
Authors: Marco L Davila; Isabelle Riviere; Xiuyan Wang; Shirley Bartido; Jae Park; Kevin Curran; Stephen S Chung; Jolanta Stefanski; Oriana Borquez-Ojeda; Malgorzata Olszewska; Jinrong Qu; Teresa Wasielewska; Qing He; Mitsu Fink; Himaly Shinglot; Maher Youssif; Mark Satter; Yongzeng Wang; James Hosey; Hilda Quintanilla; Elizabeth Halton; Yvette Bernal; Diana C G Bouhassira; Maria E Arcila; Mithat Gonen; Gail J Roboz; Peter Maslak; Dan Douer; Mark G Frattini; Sergio Giralt; Michel Sadelain; Renier Brentjens Journal: Sci Transl Med Date: 2014-02-19 Impact factor: 17.956