Терапевтический архив (Jul 2009)

Results of the treatment of adult acute lymphoblastic leukemia according to ALL-2005 protocol as a basis for new trials

  • Elena Nikolaevna Parovichnikova,
  • Yuliya Rubenovna Davidyan,
  • Valentin Grigor'evich Isaev,
  • Andrey Nikolaevich Sokolov,
  • Galina Aleksandrovna Klyasova,
  • Larisa Pavlovna Mendeleeva,
  • Lidiya Semenovna Lyubimova,
  • Elena Nikolaevna Ustinova,
  • Elena Olegovna Gribanova,
  • Elena Sergeevna Mavrina,
  • Sergey Mikhaylovich Kulikov,
  • Kamil' Daniyalovich Kaplanov,
  • Tamara Pavlovna Zagoskina,
  • Ekaterina Il'inichna Sviridova,
  • Lyubov' Vladimirovna Gavrilova,
  • Valeriy Grigor'evich Savchenko,
  • E N Parovichnikova,
  • Yu R Davidyan,
  • V G Isaev,
  • A N Sokolov,
  • G A Klyasova,
  • L P Mendeleeva,
  • L S Lyubimova,
  • E N Ustinova,
  • E O Gribanova,
  • E S Mavrina,
  • S M Kulikov,
  • K D Kaplanov,
  • T P Zagoskina,
  • E I Sviridova,
  • L V Gavrilova,
  • V G Savchenko

Journal volume & issue
Vol. 81, no. 7
pp. 8 – 15

Abstract

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Aim. To analyse the results of the treatment according to ALL-2005 protocol for adult patients with acute lymphoblastic leukemia (ALL); on the basis of the summarized evidence on ALL treatment to propose principles for development of a new program of ALL treatment in 15-55-year-old patients. Material and methods. Five hematological centers (in Moscow, Saransk, Volgograd, Tambov, Kirov) participated in ALL-2005 protocol trial initiated in 2005. A total of 71 adult patients with ALL (age median 27 years) were treated. The results of the MB-2002 study with participation of 16 patients aged 16-23 years performed in the State Hematological Research Center (SHRC) were reviewed. Results. The results of the induction therapy according to ALL-2005 protocol conducted in Moscow SHRC were good: a complete remission was achieved in 90% patients, early lethality was 6%, resistance was observed in 4%. In regional centers lethality in remission was higher, 5-year overall survival was 28% (in SHRC it was 56%), recurrence-free survival in regional center was 22% versus 51%, respectively. Long-term response by ALL-2005 and MB-2002 in patients aged 19-23 was the same, but toxicity of ALL-2005 treatment was higher (no lethality and 5, 4% in induction and remission, respectively). Conclusion. The decision was made on design of a new protocol of treatment of Ph-negative ALL for patients aged from 15 to 55 years the main principles of which are the following: continuous treatment with modification of cytostatic drugs doses depending on myelosuppression severity; assessment of tumor cells sensitivity to prednisolone and its replacement for dexametasone throughout the treatment; prolongation of L-asparaginase treatment with elevation of its total dose; monitoring of minimal residual disease (MRD) for decision on late intensification in patients with MRD at late treatment stages (5 months).

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