Treatment of Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma (ALL/LL). Results of a Single Center.

ALL/LL is a heterogenous disease with various subtypes that differ markedly in their cellular and molecular characteristics. Chemotherapy regimens, response to therapy and risk of relapse also vary among different disease subtypes. Here we report the experience in our center in the management of this heterogeneous group of haematological malignancies.

The objectives of the study are:

- To determine the event free survival (EFS) in patients diagnosed with different subtypes of ALL/LL, including those who received an allogeneic stem cell transplantation.

- To determine the overall survival (OS) for the patients diagnosed of ALL/LL and for those who received an allogeneic stem cell transplantation.

Forty-two patients have been diagnosed of ALL/LL in our hospital from February'02 to April'09. 24 male (57%) and 18 female (43%), median age of 42,5 years (18-74), including sixteen cases of B-ALL (38%); 13 Ph+ ALL (31%); 6 T-ALL (14%) and 7 LL (17%).

B and T-ALL were treated with the same chemotherapy regimen (Pethema: Spanish group for the treatment of haematological malignancies). Ph+ ALL were treated with chemotherapy and the addition of Imatinib (Pethema regimen) and Lymphoblastic Lymphomas (LL) were treated with HyperCVAD regimen. Elderly patients or those with significant comorbidities were treated with “adapted risk” chemotherapy regimens. Allogeneic stem cell transplantation, related or unrelated, was indicated in first complete remission (CR) for all cases of Ph+ ALL, and cases of B or T ALL who do not achieved CR with negative Minimal Residual Disease (MRD), or in second CR for cases with LL.

Thirty-three patients (78%) achieved CR at the end of the first induction phase. Two patients (5%) died in this phase and 5 patients (14% of the evaluable patients) relapsed at any moment of the treatment scheduled for them. Fourteen patients (33%) received an allogeneic transplantation: 7 (50%) from an unrelated donor. Nine of this 14 patients (64%) were transplanted in 1^st CR. At the moment of the study, 21 patients (50%) are alive.

The EFS for the patients included in the study is 41% with a median follow-up of 10,47 months (1,1-78,1). The EFS for the different subtypes are: 57% for B-ALL; 23% for Ph+ ALL; 44% for T-ALL and 57% for LL. The EFS for the transplanted patients is 34% and for the non transplanted patients group is 49%

The OS is 43% with a median follow up of 11,57 months (1,11-78,1). The OS for the transplanted patients is 40% and for the rest of the patients is 48%

Pethema chemotherapy regimens for B, T and Ph + ALL, achieve a good percentage of CR, according to other similar regimens of chemotherapy reported. However, toxicity and relapses are still elevated. The research of a related or unrelated HLA-identical donor must be done from the diagnosis, specially in those forms of recognized bad prognosis.

No relevant conflicts of interest to declare.