Experience of a Brazilian Institution with Treatment of Adult Acute Lymphoblastic Leukemia.

Adult Acute Lymphoblastic (ALL) is an aggressive bone marrow neoplasm, associated with a poor outcome in adult patients. The aim of this study is to compare different treatment protocols analyzing complete response after induction treatment (CR), overall survival (OS) and disease free survival (DFS). Statistical analysis was done by SPSS 10.0. The analysis of prognostic factors, protocols and response treatment was done by Pearson’s chi-square. OS and DFS curves were constructed by Kaplan-Meyer method and differences were analyzed by log-rank test.

In our institutional department, 102 patients with ALL diagnosed between 1990 and 2005 were treated with one of the follow protocols: BFM 86 modified (BFM 86M) (48/102), OPAL86 (6/102), OPAL87 (40/102) (Linker et cols; 1986Linker et cols; 1987) and CHOP (8/102). The results were analyzed retrospectively. The median follow up was 49 months. CR for BFM 86M, OPAL86, OPAL87 and CHOP was 76,7%, 100% 63,9% and 42,9%, respectively; with no statistically difference (p=0.08). OS was better with BFM 86M than with other protocols (p=0.001). BFM 86M was associated with 4-years DFS of 42,5% (median: 26,4 m) and OS of 49,5% (median: 35,4m). OPAL86, OPAL87 and CHOP had a median survival of 21, 12, and 5,5m respectively. Four-years OS of the patients treated with protocols other than BFM 86M was 16,8%.

The distribution of the clinical and laboratory data between the BFM 86M and the other protocols (OP) was compared. Age less than 18y (p=0.05) and L1 ALL (FAB) (p=0.01) were more prevalent in OP group. Myeloid expression antigens (p=0.05) and poor prognosis karyotype (e.g. Ph cromossome) (p=0.08) were more prevalent in BFM 86M group.

Age less than 35y (p=0.02), absent of fatigue at diagnosis (p=0.04), CNS not infiltrated (p=0.01) were associated to an early complete remission with OP but not with BFM 86M. Hepatomegaly, at diagnosis, was associated with poor complete remission when patients received BFM 86M protocol (p=0.02). Age less than 18y (p=0.002) and absent of hepatomegaly at diagnosis (p=0.01) were associated with a prolonged survival only in BFM 86M protocol. T-ALL (p=0.04) and infiltration of CNS (p=0.02) were related to worst survival in other protocols (OP) but not in BFM 86M. Bleeding at diagnosis for both BFM 86M and OP were related to short survival (p=0.03; p=0.01).