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Article: Poor outcome of intensive chemotherapy for adult acute lymphoblastic leukemia: A possible dose effect

TitlePoor outcome of intensive chemotherapy for adult acute lymphoblastic leukemia: A possible dose effect
Authors
Issue Date1994
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/leu
Citation
Leukemia, 1994, v. 8 n. 9, p. 1469-1473 How to Cite?
AbstractFifty consecutive adult patients with acute lymphoblastic leukemia (ALL) were treated with an intensive cyclical chemotherapy and the mean received dose of individual cytotoxic drug was retrospectively studied. The median age was 28 years. Twenty-one (43%) had white blood cell (WBC) count over 30 x 109/l. Of the 26 patients with successful cytogenetic studies, ten (28%) had unfavorable clonal chromosomal abnormalities (four Philadelphia chromosome, six others). A high complete remission (CR) rate (86%) was achieved. This was associated with delivery of 100% of the planned dosage of vincristine, prednisone, and daunorubicin at induction. Dose reduction of asparaginase, the fourth drug in the induction protocol, was recorded in 20 (40%) patients. The CR rate of these patients was not adversely affected. Dose reduction was recorded during consolidation (38 of 43 remitters) and maintenance (18 of 20 remitters) as a result of treatment toxicity. The mean received dose of teniposide, Ara-C, asparaginase, mercaptopurine, and methotrexate was 73% (SD 7%), 73% (SD 7%), 62% (SD 41%), 65% (SD 15%) and 73% (SD 17%) of the planned dosage, respectively. The 5-year overall survival and leukemia-free survival (LFS) were 11% (95% CI: 0-27%) and 13% (95% CI: 0-26%), respectively. Even standard-risk patients had 4-year LFS of only 26% (95% CI: 0-57%). Among 36 remitters not withdrawn from consolidation, there were 29 treatment failures after a median follow-up of 42 months; 25 (86%) of these were leukemia relapse, three (10%) were toxic death during consolidation, and one patient (4%) died from therapy-related myelodysplastic syndrome. We postulate inadequate drug delivery during post-remission therapy contributed to the high relapse rate in the whole group as well as the standard-risk patients.
Persistent Identifierhttp://hdl.handle.net/10722/148010
ISSN
2015 Impact Factor: 12.104
2015 SCImago Journal Rankings: 5.142
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChiu, EKWen_HK
dc.contributor.authorChan, LCen_HK
dc.contributor.authorLiang, Ren_HK
dc.contributor.authorLie, Aen_HK
dc.contributor.authorKwong, YLen_HK
dc.contributor.authorTodd, Den_HK
dc.contributor.authorChan, TKen_HK
dc.date.accessioned2012-05-29T06:10:21Z-
dc.date.available2012-05-29T06:10:21Z-
dc.date.issued1994en_HK
dc.identifier.citationLeukemia, 1994, v. 8 n. 9, p. 1469-1473en_HK
dc.identifier.issn0887-6924en_HK
dc.identifier.urihttp://hdl.handle.net/10722/148010-
dc.description.abstractFifty consecutive adult patients with acute lymphoblastic leukemia (ALL) were treated with an intensive cyclical chemotherapy and the mean received dose of individual cytotoxic drug was retrospectively studied. The median age was 28 years. Twenty-one (43%) had white blood cell (WBC) count over 30 x 109/l. Of the 26 patients with successful cytogenetic studies, ten (28%) had unfavorable clonal chromosomal abnormalities (four Philadelphia chromosome, six others). A high complete remission (CR) rate (86%) was achieved. This was associated with delivery of 100% of the planned dosage of vincristine, prednisone, and daunorubicin at induction. Dose reduction of asparaginase, the fourth drug in the induction protocol, was recorded in 20 (40%) patients. The CR rate of these patients was not adversely affected. Dose reduction was recorded during consolidation (38 of 43 remitters) and maintenance (18 of 20 remitters) as a result of treatment toxicity. The mean received dose of teniposide, Ara-C, asparaginase, mercaptopurine, and methotrexate was 73% (SD 7%), 73% (SD 7%), 62% (SD 41%), 65% (SD 15%) and 73% (SD 17%) of the planned dosage, respectively. The 5-year overall survival and leukemia-free survival (LFS) were 11% (95% CI: 0-27%) and 13% (95% CI: 0-26%), respectively. Even standard-risk patients had 4-year LFS of only 26% (95% CI: 0-57%). Among 36 remitters not withdrawn from consolidation, there were 29 treatment failures after a median follow-up of 42 months; 25 (86%) of these were leukemia relapse, three (10%) were toxic death during consolidation, and one patient (4%) died from therapy-related myelodysplastic syndrome. We postulate inadequate drug delivery during post-remission therapy contributed to the high relapse rate in the whole group as well as the standard-risk patients.en_HK
dc.languageengen_US
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/leuen_HK
dc.relation.ispartofLeukemiaen_HK
dc.subject.mesh6-Mercaptopurine - Administration & Dosageen_US
dc.subject.meshAdulten_US
dc.subject.meshAgeden_US
dc.subject.meshAntineoplastic Combined Chemotherapy Protocols - Therapeutic Useen_US
dc.subject.meshAsparaginase - Administration & Dosageen_US
dc.subject.meshCyclophosphamide - Administration & Dosageen_US
dc.subject.meshCytarabine - Administration & Dosageen_US
dc.subject.meshDaunorubicin - Administration & Dosageen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshLeucovorin - Administration & Dosageen_US
dc.subject.meshMaleen_US
dc.subject.meshMethotrexate - Administration & Dosageen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPrecursor Cell Lymphoblastic Leukemia-Lymphoma - Drug Therapy - Mortalityen_US
dc.subject.meshPrednisone - Administration & Dosageen_US
dc.subject.meshPrognosisen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshRemission Inductionen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSurvival Rateen_US
dc.subject.meshTeniposide - Administration & Dosageen_US
dc.subject.meshVincristine - Administration & Dosageen_US
dc.titlePoor outcome of intensive chemotherapy for adult acute lymphoblastic leukemia: A possible dose effecten_HK
dc.typeArticleen_HK
dc.identifier.emailChan, LC:chanlc@hkucc.hku.hken_HK
dc.identifier.emailLiang, R:rliang@hku.hken_HK
dc.identifier.emailKwong, YL:ylkwong@hku.hken_HK
dc.identifier.authorityChan, LC=rp00373en_HK
dc.identifier.authorityLiang, R=rp00345en_HK
dc.identifier.authorityKwong, YL=rp00358en_HK
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid8090027-
dc.identifier.scopuseid_2-s2.0-0028108293en_HK
dc.identifier.hkuros4667-
dc.identifier.hkuros5954-
dc.identifier.volume8en_HK
dc.identifier.issue9en_HK
dc.identifier.spage1469en_HK
dc.identifier.epage1473en_HK
dc.identifier.isiWOS:A1994PH54000006-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridChiu, EKW=24827833600en_HK
dc.identifier.scopusauthoridChan, LC=7403540707en_HK
dc.identifier.scopusauthoridLiang, R=26643224900en_HK
dc.identifier.scopusauthoridLie, A=24284842400en_HK
dc.identifier.scopusauthoridKwong, YL=7102818954en_HK
dc.identifier.scopusauthoridTodd, D=7201388182en_HK
dc.identifier.scopusauthoridChan, TK=7402687762en_HK

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