Tratamento da leucemia linfoblástica do adulto: resultados do protocolo de alto risco do GBTLI85 comparados retrospectivamente com um esquema convencional
DOI:
https://doi.org/10.32635/2176-9745.RBC.1994v40n2.2973Keywords:
Acute Lymphoblastic Leucemia, ChemotherapyAbstract
In a group of 43 patients aged over 15 years with a diagnosis of acute lymphoblastic leucemia (ALL), there were compared retrospectively the results of the modified Stein protocol (group 1) and the GBTLI85 (group 2) regimen, a intensive protocol developed for high risk childhood ALL The complete response (CR) rate was betterin group2 (54% vs. 19%, p = 0.01), but this difference had lost statistical significance after a muitivariate analysis. Once a CR was obtained, the four years disease-free survival was 25% for both groups, but in group 1 the relapse rate was 75% and in group 2, the relapse rate was 41 % and 33% of the responders died from toxicity of post remission therapy. The four years failure free survival (FFS) was 4%, for group 1 (95%, confidence interval 0-13%,) and 13% for group 2 (95% confidence interval 0-27%). In our patients, an intensive therapy based in the high risk chilhoodprotocois had failed in improving the cure rates and was associated to prohibitive toxicity rates. New approaches based in risk grouping for adult ALL must be found.
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References
CLAVELL LA, GELBER RD, COHEN HJ et al. Four agent induction and intensive asparaginase therapy for treatment of chilhood acute lymphoblastic leukemia. New EnglJ Med 1986; 315(11): 657-663. DOI: https://doi.org/10.1056/NEJM198609113151101
TUBEGER DG, GILCHRIST GS et al. Improved outcome with delayed intensification for children with acute lymphoblastic leukemia and intermediate presenting features. A Children's Cancer
Study Group Phase III Trial. J Clin Oncol 1993; 11 (3): 527-537. DOI: https://doi.org/10.1200/JCO.1993.11.3.527
HOELZER DF. Therapy of the newly diagnosed adult with acute lymphoblastic leukemia. Hematol Oncol Clin North Am 1991; 17(1): 1166-1172.
LINKER CA, LEVIT LJ, 0'D0NNELL M et al. Improved results of Adult Acute Lymphoblastic Leukemia. Blood 1987; 69(4); 1242-1248. DOI: https://doi.org/10.1182/blood.V69.4.1242.bloodjournal6941242
CLARKSON B, ELLIS S, LITTLE C et al. Acute lymphoblastic leukemia in adults. Semin Oncol 1985; 12(2): 160-179.
GAYNON PS, BLEYER WA, ALBO VC et al. Intensive therapy for children with acute lymphoblastic leukemia and unfavorable presenting factors. Early conclusion of study CCG-106 by the Children's Cancer Study Group. The Lancet 1988; 86(17): 921-923. DOI: https://doi.org/10.1016/S0140-6736(88)92596-2
HOELZER D, THIEL E, LÕFFLER H et al. Intensified therapy in acute lymphoblastic and acute undifferentiated leukemia in adults. Blood 1984; 64(1): 38-47. DOI: https://doi.org/10.1182/blood.V64.1.38.bloodjournal64138
STEIN R, FLEXNER JM, COLLINS RD et al. Effective multidrug, multimodality consolidation therapy of adult acute lymphocitic leukemia. Cancer 1982; 49(3): 846-849. DOI: https://doi.org/10.1002/1097-0142(19820301)49:5<846::AID-CNCR2820490504>3.0.CO;2-P
RADFORD JE, BURNS CP, JONES MP, GINGRICH RD et al. Adult acute lymphoblastic leukemia: results of the lowa HOP-L protocol. J Clin Oncol 1989; 17(1): 57-66. DOI: https://doi.org/10.1200/JCO.1989.7.1.58
ELLISON RR, MICK R, CUTTNER J et al. The effects of postinduction intensification treatment with cytarabine and daunorrubicin in adult acute lymphocitic leukemia: a prospective randomized clinicai trial by cancer and leukemia group B. J Clin Oncol 1991; 9(11): 2002-2015. DOI: https://doi.org/10.1200/JCO.1991.9.11.2002
HUSSEIN KK, DAHLBERG S, HEAD D et al. Treatment of acute lymphoblastic leukemia in adults with intensive induction, consolidation and maintenance chemotherapy. Blood 1991; 73 (1): 57-63. DOI: https://doi.org/10.1182/blood.V73.1.57.57
LINKER CA, LEVITT LJ, CDONNEL M et al. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemoterapy: a follow-up report. Blood 1991; 78(11): 2814-2822. DOI: https://doi.org/10.1182/blood.V78.11.2814.bloodjournal78112814
LISTER TA, WHITEHOUSE JMA, BEARD MEJ et al. Combination chemotherapy for acute lymphoblastic leukemia in adults. Br Med J 1978; 1: 199-203. DOI: https://doi.org/10.1136/bmj.1.6107.199
HOELZER D, THIEL E, LÕEFFLER H et al. Prognostic factors in a multicenter study for treatment of acute lymphoblastic leukemia in adults. Blood 1988; 71 (1): 123-131. DOI: https://doi.org/10.1182/blood.V71.1.123.bloodjournal711123
ROHATINER AZS, BASSAN R, BATISTA R et al. High dose cytosine arabinoside in the initial treatment of adults with acute lymphoblastic leukemia. Br J Cancer 1990; 62:451 -458. DOI: https://doi.org/10.1038/bjc.1990.317
OMURA GA, MOFFIT S, VOGLER WR et al. Combination chemotherapy of adult acute lymphoblastic leukemia with randomized central nervous system prophylaxis. Blood 1980; 55(2): 199-204. DOI: https://doi.org/10.1182/blood.V55.2.199.199
