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Acute Lymphocytic Leukemia (ALL)

Leukemia Insights - Spring 2007

Exciting progress has happened in adult ALL. With the hyper-CVAD regimen, the CR rate in adult ALL is 90% with a 5-10 year survival rate of 40-50% (Kantarjian.Cancer 101:2788, 2004). We are now treating adult ALL based on its subtype with protocol specific modifications.

In Ph+ ALL, the hyper-CVAD + imatinib regimen has shown encouraging data with 3 year survival rates of 60% (Thomas.Blood 103:4396, 2004). We are currently attempting to improve these results using the combination of hyper-CVAD + dasatinib (dual Src-Abl inhibitor; 300 times more potent than imatinib).

In Burkitt ALL, hyper-CVAD + rituximab has produced event-free-survival rates of 80-90%. This continues to be our current frontline regimen (Thomas.Cancer 106:1569, 2006).

In T-cell ALL, we have incorporated nelarabine (an active anti-T-All agent) with hyper-CVAD to improve on the previous positive results (Thomas. Blood 104:1624, 2004).

In adolescent-young adults (age 12-30) with ALL, pediatric dose intensive regimens appear to produce better results than standard adult ALL regimens, although no direct comparisons have been made to the hyper-CVAD regimen. Because of the literature experience, we have initiated a frontline study of augmented BFM (the pediatric protocol for high risk ALL) in our  adolescent-young adult patients.

  • Hyper-CVAD + dasatinib in Ph+ ALL – protocol 2006-0478
  • Hyper-CVAD + rituximab in Burkitt ALL – protocol ID02-229
  • Hyper-CVAD + nelarabine in T-Cell ALL – protocol 2006-0328 (pending)
  • Augmented BFM regimen in adolescent-young adults (age 12-30) – protocol 2006-0375

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