PMID- 10073558
OWN - NLM
STAT- MEDLINE
DCOM- 19990316
LR  - 20071115
IS  - 0093-7754 (Print)
IS  - 0093-7754 (Linking)
VI  - 26
IP  - 1
DP  - 1999 Feb
TI  - Dose-intensive therapy for adult acute lymphoblastic leukemia.
PG  - 6-20
AB  - Major challenges remain to be overcome to increase the cure rate for acute 
      lymphoblastic leukemia (ALL), especially for middle-aged and older adults. 
      Despite high rates of complete remission (CR), many patients relapse after 
      chemotherapy alone. Dose-intensive therapy and stem-cell transplantation (SCT) 
      have been able to rescue some of these patients. However, many patients presently 
      are being cured using intensive consolidation chemotherapy during first remission 
      (CRI) and at a lower cost and toxicity than with SCT. The use of SCT in CRI 
      should be governed by an assessment of known risk factors. Among younger adults 
      in the prime transplant age group (< 50 years), there is no advantage to 
      allogeneic (allo)-SCT across the board, but it is recommended for those with 
      Philadelphia chromosome-positive (Ph+) ALL or pro-B ALL with t(4;11) and possibly 
      for those with B-lineage ALL and initial WBC counts > 100,000/microL. There is as 
      yet no evidence that allo-SCT can improve the already high cure rate achieved 
      with chemotherapy alone in favorable subsets such as T-cell ALL. There appears to 
      be no advantage to autologous (auto)-SCT over chemotherapy for consolidation of 
      either high-risk or standard-risk patients in CRI. The argument that early use of 
      auto-SCT shortens the duration of treatment and thereby improves the quality of 
      life is not persuasive, as there is little morbidity from maintenance 
      chemotherapy. Patients who receive a modern, intensive multiagent chemotherapy 
      program for CRI but later relapse are unlikely to be cured with additional 
      chemotherapy alone. High-grade multidrug resistance develops rapidly. These 
      patients should undergo allo-SCT if possible. Unfortunately, allo-SCT is 
      available to only a minority of such patients because of the lack of a donor or 
      insurance coverage, or the presence of comorbid conditions or older age. The use 
      of alternative donors (either matched, unrelated donors or partially human 
      leukocyte antigen [HLA] matched family members) is appropriate in this 
      circumstance. Auto-SCT with or without previously used purging methods is 
      ineffective for patients with advanced ALL.
FAU - Finiewicz, K J
AU  - Finiewicz KJ
AD  - Department of Medicine, and the Cancer Research Center, University of Chicago, 
      IL, USA.
FAU - Larson, R A
AU  - Larson RA
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Semin Oncol
JT  - Seminars in oncology
JID - 0420432
SB  - IM
MH  - Adult
MH  - Antineoplastic Combined Chemotherapy Protocols/*administration & dosage/*adverse 
      effects
MH  - Clinical Trials as Topic
MH  - Drug Administration Schedule
MH  - Graft vs Host Disease
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/*surgery
MH  - Prognosis
MH  - Remission Induction
MH  - Risk
MH  - Transplantation, Autologous
MH  - Transplantation, Homologous
MH  - Treatment Outcome
RF  - 68
EDAT- 1999/03/12 00:00
MHDA- 1999/03/12 00:01
CRDT- 1999/03/12 00:00
PHST- 1999/03/12 00:00 [pubmed]
PHST- 1999/03/12 00:01 [medline]
PHST- 1999/03/12 00:00 [entrez]
PST - ppublish
SO  - Semin Oncol. 1999 Feb;26(1):6-20.