Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group
Por:
Oriol, A, Vives, S, Hernandez-Rivas, JM, Tormo, M, Heras, I, Rivas, C, Bethencourt, C, Moscardo, F, Bueno, J, Grande, C, del Potro, E, Guardia, R, Brunet, S, Bergua, J, Bernal, T, Moreno, MJ, Calvo, C, Bastida, P, Feliu, E, Ribera, JM
Publicada:
1 abr 2010
Resumen:
Background
About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia.
Design and Methods
We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials.
Results
The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%).
Conclusions
The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.
Filiaciones:
Oriol, A:
Hosp Badalona Germans Trias & Pujol, Inst Catala Oncol, Serv Hematol Clin, Badalona, Spain
Vives, S:
Hosp Badalona Germans Trias & Pujol, Inst Catala Oncol, Serv Hematol Clin, Badalona, Spain
Hernandez-Rivas, JM:
Hosp Clin Univ, Salamanca, Spain
Tormo, M:
Hosp Clin Univ, Valencia, Spain
Heras, I:
Hosp Morales Meseguer, Murcia, Spain
Rivas, C:
Gen Hosp, Alicante, Spain
Bethencourt, C:
Hosp Univ Carlos Haya, Malaga, Spain
Moscardo, F:
Hosp La Fe, E-46009 Valencia, Spain
Bueno, J:
Hosp Valle De Hebron, Barcelona, Spain
Grande, C:
Hosp Doce Octubre, Madrid, Spain
del Potro, E:
Hosp Clin San Carlos, Madrid, Spain
Guardia, R:
Hosp Josep Trueta, Girona, Spain
Brunet, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Bergua, J:
Hosp San Pedro Alcantara, Caceres, Spain
Bernal, T:
Univ Oviedo, Hosp Cent Asturias, E-33080 Oviedo, Spain
Moreno, MJ:
Hosp Virgen de la Victoria, Malaga, Spain
Calvo, C:
Hosp Miguel Servet, Zaragoza, Spain
Bastida, P:
Hosp Materno Infantil Vall Hebron, Barcelona, Spain
Feliu, E:
Hosp Badalona Germans Trias & Pujol, Inst Catala Oncol, Serv Hematol Clin, Badalona, Spain
Ribera, JM:
Hosp Badalona Germans Trias & Pujol, Inst Catala Oncol, Serv Hematol Clin, Badalona, Spain
Gold, Green Published
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