[Efficiency of treatment of adult patients with acute T-lymphoblastic leukemia according to the ALL-2009 protocol of the Russian Acute Leukemia Study Group].

Abstract

AIM:

To present the results of treatment in adult patients with acute T-lymphoblastic leukemia (T-ALL) according to the ALL-2009 protocol of the Russian Acute Leukemia Study Group, the basic principle of which is continuation of cytostatic treatment, early switch from prednisolone to dexamethasone, and long-term use of L-asparaginase.

SUBJECTS AND METHODS:

The results of diagnosis and treatment were analyzed in 70 patients with different immunological variants of T-ALL treated in the Russian multicenter trial.

RESULTS:

Out of the 70 patients with T-ALL, its early immunotype was determined in 32 (45.7%) cases, the thymic and mature immunotypes were found in 31 (44.3%) and 7 (10%) cases, respectively. The median age of the patients with T-ALL was 28 (ranged from 15 to 54) years; men were twice more than women (48 and 22, respectively). Bone marrow lesion was noted in all the patients with early T-ALL and in 80% of the patients with thymic and mature T-ALL. The enlarged mediastinum was significantly more frequently detected in mature T-ALL (100%) than in its early (53.4%) and thymic (60.7%) variants. Therapeutic effectiveness was evaluated in 58 patients. An analysis was made in January 2013. Induction therapy resulted in complete remission in 49 (84.5%) patients. The refractory course of the disease was recorded in 5 (8.6%) cases; early death was in 4 (6.9%). The rate of complete remission in thymic T-ALL, unlike in the early (72%) and mature (71.4%) variants, was significantly higher (100%) due to the absence of resistant forms and early mortality. Moreover, it should be noted that only the patients with early T-ALL (16%) died during the induction phase. In the patients with different variants of T-ALL, the overall and relapse-free survival rates were not significantly different, accounting for 67.2 and 76.2%, respectively. Multivariate analysis revealed no prognostically unfavorable factors that determined long-term results.

CONCLUSION:

The ALL-2009 protocol is reproducible in any regions of the Russian Federation and highly efficient in treating patients with T-ALL.

• Authors: E N Parovichnikova, G A Kliasova, V V Troitskaia, A N Sokolov, L A Kuz'mina, V P Mendeleeva, S K Kravchenko, V V Ryzhko, S N Bondarenko, E A Kariakina
• Journal: Terapevticheskii arkhiv (Ter Arkh) Vol. 85 Issue 8 Pg. 29-34 ( 2013) ISSN: 0040-3660 [Print] Russia (Federation)
• PMID: 24137961 (Publication Type: Clinical Trial, Comparative Study, English Abstract, Journal Article, Multicenter Study)

Chemical References

• Antineoplastic Agents, Hormonal
• Asparagine
• Dexamethasone
• Prednisolone

Topics

• Acute Disease
• Adolescent
• Adult
• Antineoplastic Agents, Hormonal (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, pharmacology)
• Asparagine (administration & dosage)
• Bone Marrow (pathology)
• Dexamethasone (administration & dosage)
• Female
• Humans
• Male
• Mediastinum (pathology)
• Middle Aged
• Precursor T-Cell Lymphoblastic Leukemia-Lymphoma (classification, drug therapy, mortality, pathology)
• Prednisolone (administration & dosage)
• Prognosis
• Remission Induction
• Russia
• Survival Rate
• Treatment Outcome
• Young Adult