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