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Acute Lymphocytic Leukemia (ALL)

Leukemia Insights - Summer 2008

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.

1. 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).

2. 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).

3. 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).

4. 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.

a. Hyper-CVAD + dasatinib in Ph+ ALL : protocol 2006-0478.
b. Hyper-CVAD + rituximab in Burkitt ALL: protocol ID02-229.
c. Hyper-CVAD + nelarabine in T-Cell ALL: protocol 2006-0328.
d. Augmented BFM regimen in adolescent-young adults (age 12-30): protocol 2006-0375.

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