Acute adult lymphocytic leukemia (ALL) is an infrequent oncologic entity whose rates of global response and cure remain unsatisfactory, when compared to results obtained in treatment of other neoplastic disorders, and of ALL itself in pediatric population, where cure rates approach 90%. Most current induction protocols achieve remission rates of 70 to 90% worldwide, but 5-year disease free survival remains unchanged. MD Anderson Cancer Center (MDACC) published their results with HyperCVAD more than a decade ago, reporting rates of complete remission of 92%, and 5-year disease free survival of 38%. We have used HyperCVAD at our center since 1999, but have not reported the baseline patient characteristics and outcomes.
We conducted a retrospective analysis on 69 patients treated with HyperCVAD from 2005 to 2009, evaluating traits at baseline and response to treatment, using descriptive statistics. Survival analysis (overall survival and disease free survival) were described using the Kaplan-Meier method. Baseline traits and their association to response were measured using Chi-square test. Comparison between the original cohort described by MDACC and ours was also analyzed by this test.
Sixty nine patients with a median follow up of 12 months (range 1–144) were evaluated. Complete remission rates were 77%; induction mortality 4.3%; the estimate of overall survival and disease free survival at 60 months was less than 10% in both cases. The pretreatment variables associated to an increased probability of achieving remission were age <30, baseline hemoglobin >10g/dL and pre B phenotype (p<0.001). Leukocyte count and baseline DHL did not predict ability to achieve remission as shown in the original MDACC study. A 15% difference in complete remission response rate between the original series and ours was found to be statistically significant (p<0.0001).
HyperCVAD as applied to Mexican patients has an efficacy similar to other remission induction protocols, as reported elsewhere, but is inferior to the original results published by MDACC. Survival analysis requires a longer median follow-up for valid conclusions to be drawn.
Perez Rocha:genzyme: Employment, Honoraria.
Asterisk with author names denotes non-ASH members.