Elsevier

Mayo Clinic Proceedings

Volume 69, Issue 10, October 1994, Pages 937-948
Mayo Clinic Proceedings

Acute Lymphocytic Leukemia in Adults: A Retrospective Study and Analysis of Current Management Options

https://doi.org/10.1016/S0025-6196(12)61817-5Get rights and content

Objective

To examine current therapeutic modalities for acute lymphocytic leukemia (ALL) in adults, analyze prognostic variables, and offer treatment recommendations.

Design

We reviewed our experience with 90 adult patients with ALL examined at the Mayo Clinic between 1982 and 1992 and used it as a background for discussion of prognostic factors and management options in adult patients with ALL.

Material and Methods

The pretreatment characteristics of patients, types of induction chemotherapy, and postremission treatment, including bone marrow transplantation (BMT), were analyzed for prognostic significance for each of three outcomes: complete remission (CR) rate, duration of CR, and overall survival of patients.

Results

Of the 90 study patients, 80 had received induction chemotherapy. Overall long-term survival for treated patients was 25%. None of the 10 patients younger than 18 years of age underwent BMT, and their long-term survival was 80%. Of the other 70 patients, who were 18 years old or older, 42 (60%) had a CR with induction chemotherapy. Of these 42 patients, 31 did not undergo BMT, and their long-term survival was less than 13%. BMT was done in six patients during a first CR (with 100% survival), in four during a later CR (with 50% survival), and in six with disease (with 17% survival). The median age of patients who received chemotherapy was 50 years (range, 19 to 87) and that of patients who underwent BMT was 34 years (range, 18 to 46). Overall, age was the only significant prognostic factor.

Conclusion

With our application of current chemotherapy, the outcome in adult patients (18 years old or older) with ALL was dismal. The results were considerably better in patients younger than 18 years of age or in those who underwent BMT as post-remission therapy. Comprehensive assessment of our experience and that in the literature, however, did not resolve issues about current management. Participation of patients in comparative trials is critical for determining the best therapy for ALL in adults.

Section snippets

Patients.

From a computer database of patients examined at the Mayo Clinic between 1982 and 1992, 384 with a diagnosis of ALL were identified. Historical review of these cases revealed 90 patients who were older than 15 years of age (adults) and fulfilled the criteria for a laboratory diagnosis of ALL (characteristic morphologic features, negative results of myeloid cytochemical studies [myeloperoxidase and nonspecific esterase], and” presence of terminal deoxynucleotidyltransferase). We used these

RESULTS

During a median follow-up of more than 7 years, the overall percentage of survival of the 90 adult patients was 23%. All 10 untreated patients had a median survival of 4 months (range, 0 to 18). These patients were untreated because of a debilitated state or refusal by the patient. The overall percentage of survival of the 80 patients who received induction chemotherapy was 25% (Fig. 1). For this group of patients, age, leukocyte count, cytogenetic patterns, leukemic phenotype, and time to

DISCUSSION

In this retrospective analysis of treatment outcome of adult patients with ALL, the major findings were (1) the superior long-term disease-free survival rate (80%) in “adolescents” (those 16 and 17 years old), (2) the dismal outcome (long-term disease-free survival rate of less than 10%) of “adults” (those 18 years old or older) who received chemotherapy only, and (3) the possible improvement in the duration of CR (100% durable first CR) with use of allogeneic BMT. In addition, currently

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  • *

    Current address: University of California San Francisco, Fresno, California.

    Current address: Syntex Corporation, Palo Alto, California.

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