Treatment Results in Adolescent and Adult Acute Lymphoblastic Leukaemia Using a Uniform Chemotherapy Protocol

Fifty-four adolescent and adult patients with newly-diagnosed acute lymphoblastic leukaemia (ALL) were treated with combination chemotherapy at three Australian hospitals. The protocol consisted of one month of induction therapy with five cytotoxic agents, followed by consolidation therapy and prophylactic treatment to the central nervous system, then maintenance chemotherapy for 30 months on an outpatient basis. Complete remission was achieved in 47 (87%) patients, with 5 deaths due to treatment-related toxicity. Two patients had drug-resistant disease. Twenty-two patients subsequently relapsed in the bone marrow (18) or in the central nervous system (4). The median survival for all 54 patients is 45.6 months, while the median duration of remission for the 47 complete responders is 39.0 months, with 38.1% projected to be disease-free at 5 years. Age at diagnosis was found to be the only parameter at presentation with a significant predictive effect on outcome. Patients between 10 and 20 years of age had a median survival of 120.6 months, with the median duration of remission not yet reached. In contrast, patients aged 20 years or more had a significantly poorer outcome, with median survival and remission of 25.8 and 20.8 months respectively. These results would support the use of intensive chemotherapy for adolescent patients with ALL. The poor results in adults however justify the use of alternative approaches such as bone marrow transplantation.