6533b7d5fe1ef96bd1263bbd

RESEARCH PRODUCT

Salvage Therapy of Adult ALL

subject

description

In a first study (1986 to 1992) the German Relapsing ALL Study Group (GRALLSG) has treated 67 adult patients with a first relapse of ALL. A first phase of induction consisted of vindesine, daunorubicin, asparaginase, and prednisone, a second phase of high-dose cytosine-arabinoside (Hd ara-C) and VP16. Results: 45 CR, 2 PR, 13 failures, 7 early death. 25 patients received a BMT. 10 had an allogeneic BMT in CR, 5 after another relapse or with refractory disease. Of 10 with autologous BMT 8 have been in 2nd CR. Only 4 of all 67 patients are surviving without relapse: One after unrelated BMT (36+mo), two after autologous BMT in 2nd CR (46+, 64+mo), and one after chemotherapy (61+mo). One patient has been lost in relapse. The median survival is 7.2 months and the overall survival 4% after 5 years. The duration of the first CR was an important risk factor for response to induction. Patients are accordingly stratified in a new protocol. Patients with a preceding 1st CR<18 months receive Hd ara-C/idarubicin. The others are treated with the phase I of the previous protocol and a consolidation of Hd MTX, ifosfamide, prednisolone, ara-C and VP16. Furtheron a phase I/II trial is performed in patients with refractory disease or multiple relapses to evaluate the activity of 2-CDA.