Effects of intensive induction and consolidation chemotherapy with idarubicin and high dose cytarabine on minimal residual disease levels in newly diagnosed adult precursor-B acute lymphoblastic leukemia

Kenneth F Bradstock; Alec Morley; Karen Byth; Jeff Szer; Ian Prosser; Paul Cannell; Ian Irving; John F Seymour

doi:10.1016/j.conctc.2016.06.004

Effects of intensive induction and consolidation chemotherapy with idarubicin and high dose cytarabine on minimal residual disease levels in newly diagnosed adult precursor-B acute lymphoblastic leukemia

Contemp Clin Trials Commun. 2016 Jun 22:4:9-13. doi: 10.1016/j.conctc.2016.06.004. eCollection 2016 Dec 15.

Authors

Kenneth F Bradstock¹, Alec Morley², Karen Byth³, Jeff Szer⁴, Ian Prosser⁵, Paul Cannell⁶, Ian Irving⁷, John F Seymour⁸

Affiliations

¹ Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia.
² Flinders University and Medical Centre, Adelaide, South Australia, Australia.
³ Research and Education Network, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Royal Melbourne Hospital and University of Melbourne, Victoria, Australia.
⁵ Canberra Hospital, Australian Capital Territory, Australia.
⁶ Royal Perth Hospital, Perth, Western Australia, Australia.
⁷ Department of Haematology, Townsville Hospital, Queensland, Australia.
⁸ Department of Haematology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia.

Abstract

An intensive induction regimen, consisting of idarubicin and high dose cytarabine, was assessed in 19 adult patients, median age 44 years, with newly diagnosed precursor-B acute lymphoblastic leukemia (ALL). Patients achieving a complete response (CR) were given an attenuated consolidation course. The primary endpoints were induction death rate and incidence of serious non-hematological toxicity. Grades 3-4 diarrhoea occurred in 47% of patients during induction. Two patients (11%) died during induction therapy, and 2 were withdrawn due to resistant disease or prolonged marrow hypoplasia. Fifteen patients achieved CR (79%), but levels of minimal residual disease (MRD) after induction were comparable with those previously observed using a modified pediatric protocol. Overall survival at 5 years was 36.8% while leukemia-free survival was 44.1%. An intensive AML protocol used in adults with ALL resulted in substantial toxicity and provided similar levels of cytoreduction to conventional ALL protocols, without improving long-term outcomes.

Keywords: Acute lymphoblastic leukemia; Adults; High dose cytarabine; Minimal residual disease.