Adult acute lymphoblastic leukemia: limitations of intensification of therapy in a developing country

Jain, Punit ; Korula, Anu ; Deshpande, Prashant ; PN, Nisham ; Abu Alex, Ansu ; Abraham, Aby ; Srivastava, Alok ; Janet, Nancy Beryl ; Lakshmi, Kavitha M. ; Balasubramanian, Poonkuzhali ; George, Biju ; Mathews, Vikram (2018) Adult acute lymphoblastic leukemia: limitations of intensification of therapy in a developing country Journal of Global Oncology (4). pp. 1-12. ISSN 2378-9506

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Purpose: Limited data exist on intensifying chemotherapy regimens in the treatment of adult acute lymphoblastic leukemia (ALL) outside the setting of a clinical trial. Materials and Methods: Retrospectively, data from 507 consecutive adults (age ≥ 15 years) with a diagnosis of ALL treated at our center were analyzed. Standard-risk (SR) patients were offered treatment with a modified German Multicenter ALL (GMALL) regimen, whereas high-risk (HR) patients were offered intensification of therapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HCVAD). Because of resource constraints, a proportion of HR patients opted to receive the same treatment regimen as used for SR patients. Results: There were 344 SR patients (67.8%) and 163 HR patients (32.2%) at diagnosis. Among the HR patients, 53 (32.5%) opted to receive intensification with the HCVAD regimen. The SR cohort showed a superior 5-year event-free survival rate compared with the HR cohort (47.3% v 23.6%, respectively; P < .001). Within the HR subgroup, there was no statistically significant difference in overall survival or event-free survival between patients who received the modified GMALL regimen (n = 59) and patients who received HCVAD (n = 53). Conclusion: Intensified therapy in the HR subset was associated with a significant increase in early treatment-related mortality and cost of treatment. A modified GMALL regimen was found to be cost-effective with clinical outcomes comparable to those achieved with more intensive regimens.

Item Type:Article
Source:Copyright of this article belongs to American Society of Clinical Oncology.
ID Code:114055
Deposited On:07 Jun 2018 10:36
Last Modified:08 Jun 2018 07:52

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