Reinforced HEAV'D therapy for adult acute lymphoblastic leukemia: Improved results and revised prognostic criteria

Thirty-six adults with acute lymphoblastic leukemia (ALL) were treated with adriamycin, vincristine. prednisolone, and asparaginase for remission induction, followed by vincristine-adriamycin-cyclophosphamide consolidation courses, cranial irradiation, a short ara-C plus VM-26 pulse, and vincristine plus cyclophosphamide rotating weekly with ara-C plus VM-26 for three months (reinforced HEAV'D). Thirty-one patients achieved a complete remission (86 per cent). Compared with historical results from a prior study, age >30 years, absolute blast count >15 × 109/1, and CD10-negative immunophenotype were not associated with higher relapse rate and shorter survival, suggesting a positive effect from intensification therapy with ara-C and VM-26 in these poor prognostic categories. However, patients with an abnormal karyotypic pattern or a positive molecular study for BCR-ABL rearrangement detecting t(9;22) had a far greater likelihood of treatment failure (probability of remission at 3 years 0·10) than those with normal karyotype or negative molecular study (probability 0·70), and those not studied or with insufficient methaphases (probability 0·50) (p<0·05 by log-rank test). These results underline the prognostic importance of chromosomal abnormalities and the usefulness of ara-C and VM-26 in the management of adult ALL.