[Optimal treatment of adult Ph negative acute lymphoblastic leukemia]

To analyze the difference of safety and efficacy between the traditional and the pediatric inspired acute lymphoblastic leukemia (ALL) chemotherapy regimen, and to further observe whether patients in different age group will benefit from the two regimens.

Adult de novo Ph negative ALL patients in our hospital from Jan 4, 2009 to Sep 4, 2013 were involved in this study and divided into 2 groups according to treatment regimens, the traditional regimen (regimen 1) and modified pediatric regimen (regimen 2) groups, respectively. The safety and the efficacy of all patients and different regimen groups were evaluated statistically.

All 144 patients received the induction therapy. The total complete remission (CR) rate was 95.8%, one course CR rate was 92.4%, and 5 year overall survival (OS) and progression free survival (RFS) were 59.0% and 48.6% respectively. The CR rate, 3 year OS and 3 year RFS between the two different regimens were 95.6% vs 96.1% (P = 0.783), 65.3% vs 63.4% (P = 0.885) and 56.0% vs 50.0% (P = 0.931), respectively. Further analysis stratified with age was also performed. For the patients treated with regimen 1, the 3 year OS and RFS between the two different age groups (14-30 years and 31-60 years) was 69.6% vs 54.7% (P = 0.042) and 56.5% vs 57.0% (P = 0.472). For the patients treated with regimen 2, the 3 year OS and RFS between the two different age groups (14-30 years and 31-60 years) was 65.7% vs 60.3% (P = 0.423) and 51.5% vs 46.6% (P = 0.655). No differences were found on the respiratory failure, cardiac dysfunction, fungal infection and intestinal obstruction between the two treatment regimen groups. The incidence of renal dysfunction for regimen 1 was lower than that of regimen 2 (P = 0.011). The incidence of bacteremia for regimen 1 was higher than that of regimen 2 (P = 0.000).

The two treatment regimens for adult Ph negative ALL patients were well tolerated and showed relative favorable CR rate and long term survival rate. The older patients (31-60 years) tended to benefit from the regiment 2 which was less intensive and consisted of more agents with low suppression to bone marrow.