Outcome of Adults with Acute Lymphocytic Leukemia (ALL) with Second Salvage Therapy

Background and Aims. The outcome of adults with ALL undergoing second salvage therapy is poorly characterized. The aim of this study was to determine the outcome and prognostic factors associated with second salvage therapy in patients with ALL.

Study Group and Methods. A total of 288 patients treated for ALL in second salvage at our institution were analyzed.

Results. 53 patients (18%) achieved complete remission (CR). The median remission duration was 7 months. The median survival was 3 months. By multivariate analysis, prognostic factors independently associated with achievement of CR were: duration of first CR, and platelet count. Patients with a first CR < 36 months and a platelet count < 50 × 10⁹/L had an expected CR rate of 7%. By multivariate analysis, prognostic factors independently associated with survival were: duration of first CR, percent of marrow blasts, platelet count, and albumin levels. Expected 12-month survival rates for patients with 0–1, 2, 3, or 4 adverse factors were 33%, 14%, 8%, and 0%, respectively. A repeat multivariate analysis using landmark assessment at 6 weeks selected achievement of CR as adding significantly to the survival benefit (p = 0.0001, hazard ratio 0.51). Only 22 patients (8%) were able to undergo allogeneic stem cell transplant as second salvage therapy; their one-year survival rate was 18%.

Conclusions. The outcome of adults with ALL undergoing second salvage therapy is poor. Novel effective therapies against ALL are needed in this subset of patients.