Response-oriented individualized induction therapy followed by intensive consolidation and maintenance for adult patients with acute lymphoblastic leukemia

The ALL-87 study of the Japan Adult Leukemia Study Group (JALSG)

Mitsune Tanimoto, Shuichi Miyawaki, Teruo Ino, Taiichi Kyo, Sakamaki Hisashi Sakamaki, Tomiki Naoe, Akira Hiraoka, Norio Asou, Toshiteru Ohshima, Kazuo Tsubaki, Kazutaka Kuriyama, Takanori Ueda, Sabro Minamil, Ken Ichi Okabe, Hidehiko Saito, Hirokazu Murakami, Masami Hirano, Hiroo Dohy, Yasusuke Onozawa, Hisamitsu Suzuki & 1 others Ryuzo Ohno

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

The Japan Adult Leukemia Study Group conducted the ALL-87 study to determine whether response-oriented induction therapy and intensive consolidation and maintenance/intensification therapies could increase complete remission (CR) rate and survival in adult acute lymphoblastic leukemia (ALL). Of 121 patients registered, 116 were evaluated. Patients' ages ranged from 15 to 72 years (median, 38 years). Induction therapy, which consisted of doxorubicin, vincristine, cyclophosphamide, L-asparaginase and prednisolone, was given in a response-oriented individualized fashion. Patients were randomly allocated either to receive or not, intrathecal chemotherapy on day 8 of the induction therapy. Complete remission (CR) was obtained in 97 (83.6%) patients (90.2% in patients of less than 50 years of age and 67.6% in patients 50 years of age or older). At a median follow-up period of 65 months, the predicted 6-year overall survival and event free survival (EFS) rates of 116 patients were 23.4 and 20.0%, respectively. Predicted 6-year survival and disease-free survival (DFS) rates of 97 CR patients were 28.2 and 24.5%, respectively. By multivariate analysis, patients under 40 years of age (P = 0.002) or those with a platelet count of more than 100000/μl (P = 0.004) were significant favorable prognostic factors for obtaining CR, and days to CR less than 50 (P = 0.003), patients under 50 years of age (P = 0.005) were significant favorable factors for longer DFS. There was no significant difference in CR rates and DFS between the two randomized groups according to the intrathecal chemotherapy on day 8. Response-oriented induction therapy produced a high CR rate, but fairly intensive consolidation and maintenance/intensification chemotherapies resulted in only a marginal effect on DFS in adult ALL. Although age is one of the most important prognostic factors in ALL, the outcome was unsatisfactory even in younger adult patients using chemotherapeutic regimen employed in this study.

Original languageEnglish
Pages (from-to)421-429
Number of pages9
JournalInternational Journal of Hematology
Volume68
Issue number4
Publication statusPublished - Dec 1998
Externally publishedYes

Fingerprint

Precursor Cell Lymphoblastic Leukemia-Lymphoma
Japan
Leukemia
Maintenance
Disease-Free Survival
Therapeutics
Survival Rate
Maintenance Chemotherapy
Asparaginase
Drug Therapy
Survival
Vincristine
Prednisolone
Platelet Count
Doxorubicin
Cyclophosphamide
Young Adult
Multivariate Analysis

Keywords

  • Acute lymphoblastic leukemia
  • Adult
  • Chemotherapy
  • Individualized therapy
  • Response-oriented therapy

ASJC Scopus subject areas

  • Hematology

Cite this

Response-oriented individualized induction therapy followed by intensive consolidation and maintenance for adult patients with acute lymphoblastic leukemia : The ALL-87 study of the Japan Adult Leukemia Study Group (JALSG). / Tanimoto, Mitsune; Miyawaki, Shuichi; Ino, Teruo; Kyo, Taiichi; Hisashi Sakamaki, Sakamaki; Naoe, Tomiki; Hiraoka, Akira; Asou, Norio; Ohshima, Toshiteru; Tsubaki, Kazuo; Kuriyama, Kazutaka; Ueda, Takanori; Minamil, Sabro; Okabe, Ken Ichi; Saito, Hidehiko; Murakami, Hirokazu; Hirano, Masami; Dohy, Hiroo; Onozawa, Yasusuke; Suzuki, Hisamitsu; Ohno, Ryuzo.

In: International Journal of Hematology, Vol. 68, No. 4, 12.1998, p. 421-429.

Research output: Contribution to journalArticle

Tanimoto, M, Miyawaki, S, Ino, T, Kyo, T, Hisashi Sakamaki, S, Naoe, T, Hiraoka, A, Asou, N, Ohshima, T, Tsubaki, K, Kuriyama, K, Ueda, T, Minamil, S, Okabe, KI, Saito, H, Murakami, H, Hirano, M, Dohy, H, Onozawa, Y, Suzuki, H & Ohno, R 1998, 'Response-oriented individualized induction therapy followed by intensive consolidation and maintenance for adult patients with acute lymphoblastic leukemia: The ALL-87 study of the Japan Adult Leukemia Study Group (JALSG)', International Journal of Hematology, vol. 68, no. 4, pp. 421-429.
Tanimoto, Mitsune ; Miyawaki, Shuichi ; Ino, Teruo ; Kyo, Taiichi ; Hisashi Sakamaki, Sakamaki ; Naoe, Tomiki ; Hiraoka, Akira ; Asou, Norio ; Ohshima, Toshiteru ; Tsubaki, Kazuo ; Kuriyama, Kazutaka ; Ueda, Takanori ; Minamil, Sabro ; Okabe, Ken Ichi ; Saito, Hidehiko ; Murakami, Hirokazu ; Hirano, Masami ; Dohy, Hiroo ; Onozawa, Yasusuke ; Suzuki, Hisamitsu ; Ohno, Ryuzo. / Response-oriented individualized induction therapy followed by intensive consolidation and maintenance for adult patients with acute lymphoblastic leukemia : The ALL-87 study of the Japan Adult Leukemia Study Group (JALSG). In: International Journal of Hematology. 1998 ; Vol. 68, No. 4. pp. 421-429.
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abstract = "The Japan Adult Leukemia Study Group conducted the ALL-87 study to determine whether response-oriented induction therapy and intensive consolidation and maintenance/intensification therapies could increase complete remission (CR) rate and survival in adult acute lymphoblastic leukemia (ALL). Of 121 patients registered, 116 were evaluated. Patients' ages ranged from 15 to 72 years (median, 38 years). Induction therapy, which consisted of doxorubicin, vincristine, cyclophosphamide, L-asparaginase and prednisolone, was given in a response-oriented individualized fashion. Patients were randomly allocated either to receive or not, intrathecal chemotherapy on day 8 of the induction therapy. Complete remission (CR) was obtained in 97 (83.6{\%}) patients (90.2{\%} in patients of less than 50 years of age and 67.6{\%} in patients 50 years of age or older). At a median follow-up period of 65 months, the predicted 6-year overall survival and event free survival (EFS) rates of 116 patients were 23.4 and 20.0{\%}, respectively. Predicted 6-year survival and disease-free survival (DFS) rates of 97 CR patients were 28.2 and 24.5{\%}, respectively. By multivariate analysis, patients under 40 years of age (P = 0.002) or those with a platelet count of more than 100000/μl (P = 0.004) were significant favorable prognostic factors for obtaining CR, and days to CR less than 50 (P = 0.003), patients under 50 years of age (P = 0.005) were significant favorable factors for longer DFS. There was no significant difference in CR rates and DFS between the two randomized groups according to the intrathecal chemotherapy on day 8. Response-oriented induction therapy produced a high CR rate, but fairly intensive consolidation and maintenance/intensification chemotherapies resulted in only a marginal effect on DFS in adult ALL. Although age is one of the most important prognostic factors in ALL, the outcome was unsatisfactory even in younger adult patients using chemotherapeutic regimen employed in this study.",
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AU - Miyawaki, Shuichi

AU - Ino, Teruo

AU - Kyo, Taiichi

AU - Hisashi Sakamaki, Sakamaki

AU - Naoe, Tomiki

AU - Hiraoka, Akira

AU - Asou, Norio

AU - Ohshima, Toshiteru

AU - Tsubaki, Kazuo

AU - Kuriyama, Kazutaka

AU - Ueda, Takanori

AU - Minamil, Sabro

AU - Okabe, Ken Ichi

AU - Saito, Hidehiko

AU - Murakami, Hirokazu

AU - Hirano, Masami

AU - Dohy, Hiroo

AU - Onozawa, Yasusuke

AU - Suzuki, Hisamitsu

AU - Ohno, Ryuzo

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N2 - The Japan Adult Leukemia Study Group conducted the ALL-87 study to determine whether response-oriented induction therapy and intensive consolidation and maintenance/intensification therapies could increase complete remission (CR) rate and survival in adult acute lymphoblastic leukemia (ALL). Of 121 patients registered, 116 were evaluated. Patients' ages ranged from 15 to 72 years (median, 38 years). Induction therapy, which consisted of doxorubicin, vincristine, cyclophosphamide, L-asparaginase and prednisolone, was given in a response-oriented individualized fashion. Patients were randomly allocated either to receive or not, intrathecal chemotherapy on day 8 of the induction therapy. Complete remission (CR) was obtained in 97 (83.6%) patients (90.2% in patients of less than 50 years of age and 67.6% in patients 50 years of age or older). At a median follow-up period of 65 months, the predicted 6-year overall survival and event free survival (EFS) rates of 116 patients were 23.4 and 20.0%, respectively. Predicted 6-year survival and disease-free survival (DFS) rates of 97 CR patients were 28.2 and 24.5%, respectively. By multivariate analysis, patients under 40 years of age (P = 0.002) or those with a platelet count of more than 100000/μl (P = 0.004) were significant favorable prognostic factors for obtaining CR, and days to CR less than 50 (P = 0.003), patients under 50 years of age (P = 0.005) were significant favorable factors for longer DFS. There was no significant difference in CR rates and DFS between the two randomized groups according to the intrathecal chemotherapy on day 8. Response-oriented induction therapy produced a high CR rate, but fairly intensive consolidation and maintenance/intensification chemotherapies resulted in only a marginal effect on DFS in adult ALL. Although age is one of the most important prognostic factors in ALL, the outcome was unsatisfactory even in younger adult patients using chemotherapeutic regimen employed in this study.

AB - The Japan Adult Leukemia Study Group conducted the ALL-87 study to determine whether response-oriented induction therapy and intensive consolidation and maintenance/intensification therapies could increase complete remission (CR) rate and survival in adult acute lymphoblastic leukemia (ALL). Of 121 patients registered, 116 were evaluated. Patients' ages ranged from 15 to 72 years (median, 38 years). Induction therapy, which consisted of doxorubicin, vincristine, cyclophosphamide, L-asparaginase and prednisolone, was given in a response-oriented individualized fashion. Patients were randomly allocated either to receive or not, intrathecal chemotherapy on day 8 of the induction therapy. Complete remission (CR) was obtained in 97 (83.6%) patients (90.2% in patients of less than 50 years of age and 67.6% in patients 50 years of age or older). At a median follow-up period of 65 months, the predicted 6-year overall survival and event free survival (EFS) rates of 116 patients were 23.4 and 20.0%, respectively. Predicted 6-year survival and disease-free survival (DFS) rates of 97 CR patients were 28.2 and 24.5%, respectively. By multivariate analysis, patients under 40 years of age (P = 0.002) or those with a platelet count of more than 100000/μl (P = 0.004) were significant favorable prognostic factors for obtaining CR, and days to CR less than 50 (P = 0.003), patients under 50 years of age (P = 0.005) were significant favorable factors for longer DFS. There was no significant difference in CR rates and DFS between the two randomized groups according to the intrathecal chemotherapy on day 8. Response-oriented induction therapy produced a high CR rate, but fairly intensive consolidation and maintenance/intensification chemotherapies resulted in only a marginal effect on DFS in adult ALL. Although age is one of the most important prognostic factors in ALL, the outcome was unsatisfactory even in younger adult patients using chemotherapeutic regimen employed in this study.

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