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High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden

Kozlowski, Piotr; Astrom, Maria; Ahlberg, Lucia; Bernell, Per; Hulegardh, Erik; Hagglund, Hans; Karlsson, Karin LU ; Markuszewska-Kuczymska, Alicja; Tomaszewska-Toporska, Beata and Smedmyr, Bengt, et al. (2014) In European Journal of Haematology 92(5). p.377-381
Abstract
Background Hyper-CVAD is widely used to treat acute lymphoblastic leukemia (ALL) and aggressive lymphomas. This multicenter, population-based study assessed the efficacy of Hyper-CVAD as first-line therapy in patients with T-cell ALL (T-ALL). Patients and methods Between October 2002 and September 2006, 24 patients were diagnosed with T-ALL in Sweden; 19 were eligible for treatment with the protocol. Results The median age was 32yr (range 18-72yr). Complete remission (CR) was obtained in 17 of 19 (89%) patients, and the treatment was relatively well tolerated. Allogeneic stem cell transplantation (SCT) was recommended in high-risk disease and was performed in four patients upfront. Two- and 5-yr leukemia-free survivals (LFS) in 17 patients... (More)
Background Hyper-CVAD is widely used to treat acute lymphoblastic leukemia (ALL) and aggressive lymphomas. This multicenter, population-based study assessed the efficacy of Hyper-CVAD as first-line therapy in patients with T-cell ALL (T-ALL). Patients and methods Between October 2002 and September 2006, 24 patients were diagnosed with T-ALL in Sweden; 19 were eligible for treatment with the protocol. Results The median age was 32yr (range 18-72yr). Complete remission (CR) was obtained in 17 of 19 (89%) patients, and the treatment was relatively well tolerated. Allogeneic stem cell transplantation (SCT) was recommended in high-risk disease and was performed in four patients upfront. Two- and 5-yr leukemia-free survivals (LFS) in 17 patients with CR achievement were identical, at 29% (95% confidence interval [CI]: 8-51). Two- and 5-yr overall survival (OS) in whole cohort was 63% (95% CI: 42-85) and 47% (95% CI: 26-69), respectively. The 5-yr LFS for 15 patients who did not receive allogeneic SCT upfront were 20% (95% CI: 0-40), although 14 of 15 completed the protocol (eight cycles). Relapse occurred in 2 of 4 upfront-transplanted patients and in 12 of 15 patients treated with chemotherapy alone, six of whom received allogeneic SCT in CR2. Age >= 35yr influenced OS negatively in univariate analysis (HR 5.1, 95% CI: 1.55-16.7). Conclusions Hyper-CVAD treatment resulted in a high CR rate and appeared safe, but it showed poor efficacy at preventing relapse. Therefore, this treatment is no longer recommended for adults with T-ALL in Sweden. (Less)
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published
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keywords
antineoplastic combined chemotherapy protocols, treatment outcome, precursor T-cell lymphoblastic leukemia-lymphoma, stem cell, transplantation
in
European Journal of Haematology
volume
92
issue
5
pages
377 - 381
publisher
Wiley-Blackwell
external identifiers
  • wos:000334267500002
  • scopus:84898801134
ISSN
1600-0609
DOI
10.1111/ejh.12269
language
English
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yes
id
3b5a8885-dd91-4159-a389-0c85ce3dfaec (old id 4438856)
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2014-07-01 07:43:03
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2017-10-29 03:09:02
@article{3b5a8885-dd91-4159-a389-0c85ce3dfaec,
  abstract     = {Background Hyper-CVAD is widely used to treat acute lymphoblastic leukemia (ALL) and aggressive lymphomas. This multicenter, population-based study assessed the efficacy of Hyper-CVAD as first-line therapy in patients with T-cell ALL (T-ALL). Patients and methods Between October 2002 and September 2006, 24 patients were diagnosed with T-ALL in Sweden; 19 were eligible for treatment with the protocol. Results The median age was 32yr (range 18-72yr). Complete remission (CR) was obtained in 17 of 19 (89%) patients, and the treatment was relatively well tolerated. Allogeneic stem cell transplantation (SCT) was recommended in high-risk disease and was performed in four patients upfront. Two- and 5-yr leukemia-free survivals (LFS) in 17 patients with CR achievement were identical, at 29% (95% confidence interval [CI]: 8-51). Two- and 5-yr overall survival (OS) in whole cohort was 63% (95% CI: 42-85) and 47% (95% CI: 26-69), respectively. The 5-yr LFS for 15 patients who did not receive allogeneic SCT upfront were 20% (95% CI: 0-40), although 14 of 15 completed the protocol (eight cycles). Relapse occurred in 2 of 4 upfront-transplanted patients and in 12 of 15 patients treated with chemotherapy alone, six of whom received allogeneic SCT in CR2. Age >= 35yr influenced OS negatively in univariate analysis (HR 5.1, 95% CI: 1.55-16.7). Conclusions Hyper-CVAD treatment resulted in a high CR rate and appeared safe, but it showed poor efficacy at preventing relapse. Therefore, this treatment is no longer recommended for adults with T-ALL in Sweden.},
  author       = {Kozlowski, Piotr and Astrom, Maria and Ahlberg, Lucia and Bernell, Per and Hulegardh, Erik and Hagglund, Hans and Karlsson, Karin and Markuszewska-Kuczymska, Alicja and Tomaszewska-Toporska, Beata and Smedmyr, Bengt and Amini, Rose-Marie and Hallbook, Helene},
  issn         = {1600-0609},
  keyword      = {antineoplastic combined chemotherapy protocols,treatment outcome,precursor T-cell lymphoblastic leukemia-lymphoma,stem cell,transplantation},
  language     = {eng},
  number       = {5},
  pages        = {377--381},
  publisher    = {Wiley-Blackwell},
  series       = {European Journal of Haematology},
  title        = {High relapse rate of T cell acute lymphoblastic leukemia in adults treated with Hyper-CVAD chemotherapy in Sweden},
  url          = {http://dx.doi.org/10.1111/ejh.12269},
  volume       = {92},
  year         = {2014},
}