Adult and childhood acute lymphocytic leukemia: are they different diseases?

Acute leukemias in Piauí: comparison with features observed in other regions of Brazil

Differences in age and sex distribution as well as FAB (French-American-British classification) types have been reported for acute leukemias in several countries. We studied the demographics and response to treatment of patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) between 1989 and 2000 in Teresina, Piau , and compared these results with reports from Brazil and other countries. Complete data concerning 345 patients (230 ALL, 115 AML) were reviewed. AML occurred predominantly in adults (77%), with a median age of 34 years, similar to that found in the southeast of Brazil but lower than the median age in the United States and Europe (52 years). FAB distribution was similar in children and adults and FAB-M2 was the most common type, as also found in Japan. The high frequency of FAB-M3 described in most Brazilian studies and for Hispanics in the United States was not observed. Overall survival for adults was 40%, similar to other studies in Brazil. A high mortality rate was observed during induction. No clinical or hematological parameter influenced survival in the Cox model. ALL presented the characteristic peak of incidence between 2-8 years. Most of the cases were CD10+ pre-B ALL. In 25%, abnormal expression of myeloid antigens was observed. Only 10% of the patients were older than 30 years. Overall survival was better for children. Age and leukocyte count were independent prognostic factors. These data demonstrate that, although there are regional peculiarities, the application of standardized treatments and good supportive care make it possible to achieve results observed in other countries for the same chemotherapy protocols.

Acute lymphocytic leukemia in adults: a retrospective study and analysis of current management options

OBJECTIVE

To examine current therapeutic modalities for acute lymphocytic leukemia (ALL) in adults, analyze prognostic variables, and offer treatment recommendations.

DESIGN

We reviewed our experience with 90 adult patients with ALL examined at the Mayo Clinic between 1982 and 1992 and used it as a background for discussion of prognostic factors and management options in adult patients with ALL.

MATERIAL AND METHODS

The pretreatment characteristics of patients, types of induction chemotherapy, and postremission treatment, including bone marrow transplantation (BMT), were analyzed for prognostic significance for each of three outcomes: complete remission (CR) rate, duration of CR, and overall survival of patients.

RESULTS

Of the 90 study patients, 80 had received induction chemotherapy. Overall long-term survival for treated patients was 25%. None of the 10 patients younger than 18 years of age underwent BMT, and their long-term survival was 80%. Of the other 70 patients, who were 18 years old or older, 42 (60%) had a CR with induction chemotherapy. Of these 42 patients, 31 did not undergo BMT, and their long-term survival was less than 13%. BMT was done in six patients during a first CR (with 100% survival), in four during a later CR (with 50% survival), and in six with disease (with 17% survival). The median age of patients who received chemotherapy was 50 years (range, 19 to 87) and that of patients who underwent BMT was 34 years (range, 18 to 46). Overall, age was the only significant prognostic factor.

CONCLUSION

With our application of current chemotherapy, the outcome in adult patients (18 years old or older) with ALL was dismal. The results were considerably better in patients younger than 18 years of age or in those who underwent BMT as post-remission therapy. Comprehensive assessment of our experience and that in the literature, however, did not resolve issues about current management. Participation of patients in comparative trials is critical for determining the best therapy for ALL in adults.

Adult acute lymphoblastic leukemia: results of an aggressive regimen in India

A total of 42 adults with acute lymphoblastic leukemia were treated with an aggressive induction/consolidation chemotherapy (MCP-841) between June 1986 and December 1991. 32 patients (76.19%) achieved complete remission at the end of induction. There were 9 induction deaths, 6 of them due to infection. All patients received cranial irradiation in the dose of 20 Gy and intrathecal methotrexate for CNS prophylaxis. Twelve patients relapsed, 10 in the bone marrow, one case had isolated CNS relapse and the other relapsed in the bone marrow and CNS. The actuarial overall survival of all patients at the end of 5 years was 41.94%. Patient characteristics including age, sex, FAB morphology, phenotype, WBC count, platelet count and LDH did not influence survival significantly.

Acute lymphoblastic leukaemia in the elderly

Acute lymphoblastic leukaemia (ALL) is rare in adults over the age of 60 years, with an incidence of 1 per 100,000 per year. We review the current (sparse) literature and our Regional experience of 62 consecutive cases of ALL in this age group collected over a ten year period. The patterns of cytogenetic abnormalities and immunophenotypes differs from those seen in ALL in childhood and young adults, but are similar to those reported in previous studies. B-ALL was found at twice the rate observed in younger adults (9/51 versus 6/99) and T-ALL was rare (2/51). In our patients we had few cytogenetic results but in the literature up to 50% of patients have been found to be Philadelphia positive, supporting the hypothesis that ALL in this group is often a stem cell disorder. In our patients treatment results were disappointing, with only 30% of those given 'curative' treatment achieving a complete remission, and a relapse rate of 92%, mirroring other published series. The overall four year survival was 4%. We conclude that ALL in the elderly is a rare condition with an extremely poor prognosis. Aggressive treatment may prolong life but it seldom cures.

Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

The clinical outlook for adults with acute lymphoblastic leukemia (ALL) has improved with the use of intensive chemotherapy. Complete remissions (CR) are achieved in 80% of adults but the majority relapse on maintenance chemotherapy and a few exhibit primary resistance to induction therapy. This report compares the various salvage treatments and provides guidance in selecting a regimen with the optimum clinical outcome. Regimens using high-dose ara-C (HDAC) in combination with mitoxantrone, amsacrine, or idarubicin are superior to HDAC alone or with L-asparaginase. The sequential administration of methotrexate and L-asparaginase is equally effective. The duration of second CR is short for all chemotherapeutic regimens.