Results of a multicentre study of the treatment of acute lymphoblastic leukaemia in adolescents and adults (1978-1981)

Adolescents and adult patients with acute lymphoblastic leukaemia (ALL) were treated by a standardized protocol. Complete remission was attained in 62 (of 81) patients (76 per cent) with vincristine, prednisone, daunorubicin (in 7 cases with additional cytosine arabinoside). Central nervous system (CNS) involvement was prevented by periodic intrathecal MTX injections. Maintenance therapy consisted of oral MTX and 6-mercaptopurine, alternated with reinduction courses (vincristine, prednisone, daunorubicin and intrathecal MTX). Median duration of remission was 13 months for all patients; 5 months for those with an initial WBC count in excess of 20 x 10 9/l, and 20 months for those with a lower WBC count. The presence of initial CNS involvement and T-cell markers was not of major prognostic significance. Chromosomal abnormalities at the time of diagnosis were found in 62 per cent of the patients tested. Relapses were confined to bone marrow (BM; 14), CNS (5), BM + CNS (1), BM + testis (2), BM + lymph nodes (1) and the eye (1). Second remissions were attained in 50 per cent of these patients. The median survival of all remission patients was approximately 22 months. The high frequency of early medullary and extramedullary relapses has so far hampered substantial progress in the management of adult.