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Induction therapy by frequent administration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acute lymphoblastic leukemia: the JALSG-ALL93 study

Leukemia volume 16, pages 1259–1266 (2002)Cite this article

Abstract

In order to improve the disappointing prognosis of adult patients with acute lymphoblastic leukemia (ALL), we applied similar induction therapy as that used for acute myeloid leukemia (AML), ie frequent administration of doxorubicin (DOX). DOX 30 mg/m2 was administered from days 1 to 3 and from days 8 to 10 together with vincristine, prednisolone, cyclophosphamide and L-asparaginase, followed by three courses of consolidation and four courses of intensification. From December 1993 to February 1997, 285 untreated adult patients with de novo ALL were entered. Of 263 evaluable patients (age 15 to 59; median 31), 205 (78%) obtained complete remission (CR). At a median follow-up period of 63 months, the predicted 6-year overall survival (OS) rate of all patients was 33%, and disease-free survival (DFS) rate of CR patients was 30%, respectively. By multivariate analysis, favorable prognostic factors for the achievement of CR were age <40 and WBC <50 000/μl; for longer OS were age <30 and WBC <30 000/μl; and for longer DFS of CR patients were FAB L1 and ALT <50 IU/l. Among 229 patients who had adequate cytogenetic data, 51 (22%) had Philadelphia (Ph) chromosome. Ph-negative chromosome was a common favorable prognostic factor for CR, longer OS and DFS. DFS was not different between early sequential intensification (n = 48) and intermittent intensification (n = 43) during the maintenance phase. Among CR patients under 40 years old, the 6-year survival was not different between the allocated related allo-BMT group (34 patients) and the allocated chemotherapy group (108 patients). However, among patients with Ph-positive ALL, the survival of patients who actually received allo-BMT was superior to that of patients who received chemotherapy (P = 0.046).

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Acknowledgements

The authors are grateful to all participating physicians from 40 institutions in the Japan Adult Leukemia Study Group for their cooperation with this study. Thanks also to Ms Yuko Makino for her excellent secretarial assistance. This study was supported, in part, by Grants-in-Aid for Cancer Research 9–2 from the Ministry of Health and Welfare, Japan.

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Authors and Affiliations

  1. First Department of Internal Medicine, Nihon University School of Medicine, Japan

    J Takeuchi & T Ohshima

  2. Department of Internal Medicine, Hiroshima Red Cross Hospital, Japan

    T Kyo

  3. Division of Hematology, Komaki City Hospital, Japan

    K Naito

  4. Department of Hematology, Meitetsu Hospital, Japan

    H Sao

  5. Department of Hematology-Oncology, St Marianna University School of Medicine, Japan

    M Takahashi

  6. Department of Hematology, Maebashi Saiseikai Hospital, Japan

    S Miyawaki

  7. Department of Hematology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Japan

    K Kuriyama

  8. Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan

    S Ohtake

  9. First Department of Internal Medicine, Saitama Medical School, Japan

    F Yagasaki

  10. Third Department of Internal Medicine, Gunma University School of Medicine, Japan

    H Murakami

  11. Second Department of Internal Medicine, Kumamoto University School of Medicine, Japan

    N Asou

  12. Department of Internal Medicine, School of Medicine, Fujita Health University, Japan

    T Ino

  13. Second Department of Internal Medicine, Hyogo College of Medicine, Japan

    T Okamoto

  14. Division of Hematology and Oncology, Department of Internal Medicine, Jikei University School of Medicine, Japan

    N Usui

  15. Second Department of Internal Medicine, Chiba University School of Medicine, Japan

    M Nishimura

  16. Second Department of Internal Medicine, Okayama University School of Medicine, Japan

    K Shinagawa

  17. First Department of Internal Medicine, Fukui Medical University, Japan

    T Fukushima

  18. Third Department of Internal Medicine, Kochi Medical School, Japan

    H Taguchi

  19. Second Department of Internal Medicine, Nara Medical University, Japan

    T Morii

  20. Department of Internal Medicine, Anjo Kosei Hospital, Japan

    S Mizuta

  21. Department of Hematology, Tokyo Metropolitan Komagome Hospital, Japan

    H Akiyama

  22. Department of Hematology, Dokkyo University School of Medicine, Japan

    Y Nakamura

  23. Aichi Cancer Center, Japan

    R Ohno

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Takeuchi, J., Kyo, T., Naito, K. et al. Induction therapy by frequent administration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acute lymphoblastic leukemia: the JALSG-ALL93 study. Leukemia 16, 1259–1266 (2002). https://doi.org/10.1038/sj.leu.2402526

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