Outcome of adults with acute lymphocytic leukemia in second or subsequent complete remission

The outcome of adults with acute lymphocytic leukemia (ALL) who achieve a complete response (CR) on salvage therapy is thought to be poor, but not previously analyzed. To define the course of adult ALL post CR on salvage therapy and the effects of pretreatment factors on prognosis. One hundred seventy-two adults with ALL who achieved a second or third CR on salvage therapy were reviewed. Prognostic factors affecting survival were analyzed by multivariate analysis. The median survival post achieving CR for the entire group was 10 months. The estimated 1-year survival rate was 42%. Forty-three patients underwent stem cell transplant in subsequent CR: their median survival was 12 months and the 3-year survival rate was 25%. Independent poor prognostic factors for survival were age  > 55 years, duration of first CR < 12 months, and lactate dehydrogenase levels > 1000 IU/L. This analysis defines the outcome of adult ALL in CR post salvage therapy and the prognostic factors influencing survival. These results could be used in assessing the efficacy of new treatments aimed at improving CR durations and survival post salvage therapy.