Sixteen years study of acute lymphoblastic leukemia in adults at All India Institute of Medical Sciences(AIIMS), New Delhi

Abstract

This report presents retrospective analysis of 215(median age 21 years; male 75 percent) adult ALL patients alt AIIMS from 1975 to 1991. Pre-treatment characteristics revealed higher proportion of T-ALL(51 percent) mediastinal mass(20 percent), CNS disease(12 percent) and high WBC count of more than 50,000/uul(37 percent). Consistent improvemtn in remission rate as well as 5 year survival over 2 decades coincided with modifications in therapy. With 2 drug induction, inconsisteent CNS prophylaxis and oral maintenance, remission rate of 52 percent and 5 year survival of 17 percent was observed (from 1975-1980). Addition of third drug to induction therapy increased remission rate to 57 percent and 5 year survival to 23 percent(statistically insignificant improvement). Consistent CNS prophylaxis, improvements in support therapy as well as addition of early intensification from 1989 onwards, resulted in remission rate of 90 percent and expected five year survival of 33 percent. Remission duration, however, has remained unchanged. Indian patients though younger in age may be at higher risk of relapse due to high leukemic burden at presentation. Innovative approaches to further improve their outcome are required.