BMSEHA15
Published online 9 February 2010
(Haematologica 2010, 10.3324/haematol.2009.014274)
Copyright © 2010 by Ferrata Storti Foundation
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Article

Outcome after relapse of acute lymphoblastic leukemia (ALL) in adult patients included in four consecutive risk-adapted trials from the PETHEMA Study Group

Albert Oriol1, Susana Vives1, Jesús-María Hernández-Rivas2, Mar Tormo3, Inmaculada Heras4, Concepción Rivas5, Concepción Bethencourt6, Federico Moscardó7, Javier Bueno8, Carlos Grande9, Eloy del Potro10, Ramon Guardia11, Salut Brunet12, Juan Bergua13, Teresa Bernal14, Maria-José Moreno15, Carlota Calvo16, Pilar Bastida17, Evarist Feliu1, Josep-Maria Ribera1 for the Programa Español de Tratamiento en Hematologia (PETHEMA) Group

1 Servei d’Hematologia Clínica, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
2 Hospital Clínico Universitario, Salamanca
3 Hospital Clínico Universitario, Valencia
4 Hospital Morales Meseguer, Murcia
5 Hospital General, Alicante
6 Hospital Universitario Carlos Haya, Málaga
7 Hospital La Fe, Valencia
8 Hospital de la Vall d’Hebron, Barcelona
9 Hospital Doce de Octubre, Madrid
10 Hospital Clínico San Carlos, Madrid
11 Hospital Josep Trueta, Girona
12 Hospital de Sant Pau, Barcelona
13 Hospital San Pedro de Alcántara, Cáceres
14 Hospital Central de Asturias, Oviedo
15 Hospital Virgen de la Victoria, Málaga
16 Hospital Miguel Servet, Zaragoza
17 Hospital Materno-Infantil de la Vall d’Hebron, Barcelona, Spain

Correspondence: Albert Oriol, Servei d’Hematologia Clínica, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Ctra. Del Canyet s/n 08916 Badalona. Barcelona. Spain. Phone: international +34.93.4978987. Fax: international +34.93.4978995. E-mail: aoriol{at}iconcologia.net

ABSTRACT

Background and Objectives: About one half of adults with acute lymphoblastic leukemia (ALL) are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed ALL.

Patients and Methods: We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult ALL patients (excluding mature B-ALL) prospectively enrolled in four consecutive risk-adapted PETHEMA trials.

Results: The median overall survival (OS) after relapse was 4.5 months (95%CI 4-5 months) with a 5-yr-OS of 10% (95% CI, 8%–12%); 45% of patients receiving intensive second line treatment achieved a second complete remission (CR2) and 22% (95%CI, 14%–30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 (2-year-OS of 21% versus 10%; P < 0.022) and more than 2 years of duration of first remission (2-year-OS of 36% versus 17%; P < 0.001). Patients with less than 30 years and a first CR lasting over 2 years had a 5-year-OS of 38% (95%CI, 23%–53%) and a 5-year-DFS of 53% (95%CI, 34%–72%).

Interpretation and conclusions: The prognosis of adult ALL patients who relapse is poor. Those aged less than 30 years with a first CR longer than 2 years have reasonable possibilities of becoming long term survivors while patients over this age or relapsing early can not be successfully rescued using the therapies currently available.

Key words: acute lymphoblastic leukemia, relapse, rescue treatment, prognostic factors.