Page 1205 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 66 Acute Lymphoblastic Leukemia in Adults 1053

SURVIVORSHIP HEMATOPOIETIC STEM CELL TRANSPLANTATION

Although fewer specific data are available on long-term complications Bachanova V, Verneris MR, DeFor T, et al: Prolonged survival in adults with
of survivors of young adults with ALL, the long-term complications acute lymphoblastic leukemia after reduced-intensity conditioning with
of successful treatment of children with ALL have been well described cord blood or sibling donor transplantation. Blood 113:2902, 2009.
and include neurocognitive and neurologic dysfunction, endocrine Cornelissen JJ, van der Holt B, Verhoef GE, et al: Myeloablative allogeneic
and metabolic abnormalities (including obesity), bone toxicity versus autologous stem cell transplantation in adult patients with acute
(osteonecrosis), cardiac toxicity, and secondary malignancies. To lymphoblastic leukemia in first remission: a prospective sibling donor
guide the frequency and focus of medical visits and the ordering of versus no-donor comparison. Blood 113:1375, 2009.
appropriate surveillance tests, comprehensive guidelines have been Dhedin N, Dombret H, Thomas X, et al: Autologous stem cell transplantation
published in many countries, including North America, where in adults with acute lymphoblastic leukemia in first complete remission:
guidelines created by the COG, titled “Long-Term Follow-up Guide- analysis of the LALA-85, -87 and -94 trials. Leukemia 20:336, 2006.
lines for Survivors of Childhood, Adolescent and Young Adult Goldstone AH, Richards SM, Lazarus HM, et al: In adults with standard-risk
Cancers” are available at http://www.survivorshipguidelines.org and acute lymphoblastic leukemia, the greatest benefit is achieved from a
should be adopted by the adult oncology community. matched sibling allogeneic transplantation in first complete remission,
and an autologous transplantation is less effective than conventional
consolidation/maintenance chemotherapy in all patients: final results of
FUTURE DIRECTIONS the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood
111:1827, 2008.
ALL is a heterogeneous group of diseases with varied clinical out- Marks DI, Wang T, Perez WS, et al: The outcome of full-intensity and
comes, depending on molecular, cytogenetic, and clinical character- reduced-intensity conditioning matched sibling or unrelated donor
ization. There have been significant advances in our understanding transplantation in adults with Philadelphia chromosome-negative acute
of the molecular pathogenesis of this disease, which should translate lymphoblastic leukemia in first and second complete remission. Blood
into effective targeted therapies and better patient outcomes. Given 116:366, 2010.
the rarity of this disease, it is strongly recommended that patients are Tomblyn MB, Arora M, Baker KS, et al: Myeloablative hematopoietic cell
referred to centers of expertise, and it is crucial that patients be transplantation for acute lymphoblastic leukemia: analysis of graft sources
enrolled in clinical trials designed to evaluate subset-specific therapies and long-term outcome. J Clin Oncol 27:3634, 2009.
to improve survival.

STANDARD TREATMENT REGIMENS
SUGGESTED READINGS
Kantarjian HM, O’Brien S, Smith TL, et al: Results of treatment with hyper-
EPIDEMIOLOGY, CLASSIFICATION AND PROGNOSIS CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia.
J Clin Oncol 18:547, 2000.
Borowitz MJ, Chan JKC: B-lymphoblastic leukaemia/lymphoma with Larson RA, Dodge RK, Burns CP, et al: A five-drug remission induction
recurrent genetic abnormalities. In Swerdlow SH, Camp E, Harris NL, regimen with intensive consolidation for adults with acute lymphoblastic
et al, editors: WHO classification of tumors of haematopoietic and lymphoid leukemia: cancer and leukemia group B study 8811. Blood 85:2025,
tissues, Lyon, France, 2008, IARC, p 171. 1995.
Fielding AK, Richards SM, Chopra R, et al: Outcome of 609 adults after Lazarus HM, Richards SM, Chopra R, et al: Central nervous system involve-
relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ ment in adult acute lymphoblastic leukemia at diagnosis: results from
ECOG 2993 study. Blood 109:944, 2007. the international ALL trial MRC UKALL XII/ECOG E2993. Blood
Gale KB, Ford AM, Repp R, et al: Backtracking leukemia to birth: identifica- 108:465, 2006.
tion of clonotypic gene fusion sequences in neonatal blood spots. Proc Vignetti M, Fazi P, Cimino G, et al: Imatinib plus steroids induces complete
Natl Acad Sci USA 94:13950, 1997. remissions and prolonged survival in elderly Philadelphia chromosome-
Moorman AV, Chilton L, Wilkinson J, et al: A population-based cytogenetic positive patients with acute lymphoblastic leukemia without additional
study of adults with acute lymphoblastic leukemia. Blood 115:206, chemotherapy: results of the Gruppo Italiano Malattie Ematologiche
2010. dell’Adulto (GIMEMA) LAL0201-B protocol. Blood 109:3676, 2007.
Mullighan CG, Su X, Zhang J, et al: Deletion of IKZF1 and prognosis in Rowe JM, Buck G, Burnett AK, et al: Induction therapy for adults with
acute lymphoblastic leukemia. N Engl J Med 360:470, 2009. acute lymphoblastic leukemia: results of more than 1500 patients from
Roberts KG, Li Y, Payne-Turner D, et al: Targetable kinase-activating lesions the international ALL trial: MRC UKALL XII/ECOG E2993. Blood
in Ph-like acute lymphoblastic leukemia. N Engl J Med 371:1005, 106:3760, 2005.
2014. Salzer WL, Asselin B, Supko JG, et al: Erwinia asparaginase achieves thera-
Wetzler M, Dodge RK, Mrozek K, et al: Prospective karyotype analysis in peutic activity after pegasparagase allergy: a report from the Children’s
adult acute lymphoblastic leukemia: the cancer and leukemia Group B Oncology Group. Blood 122:507, 2013.
experience. Blood 93:3983, 1999. Thomas X, Boiron JM, Huguet F, et al: Outcome of treatment in adults
with acute lymphoblastic leukemia: analysis of the LALA-94 trial. J Clin
Oncol 22:4075, 2004.
CLINICAL SIGNIFICANCE OF MRD

Bassan R, Spinelli O, Oldani E, et al: Improved risk classification for risk- ADOLESCENT AND YOUNG ADULTS
specific therapy based on the molecular study of minimal residual disease
(MRD) in adult acute lymphoblastic leukemia (ALL). Blood 113:4153, DeAngelo DJ, Dahlberg S, Silverman LB, et al: A Multicenter Phase II Study
2009. Using a Dose Intensified Pediatric Regimen in Adults with Untreated
Campana D: Minimal residual disease in acute lymphoblastic leukemia. Acute Lymphoblastic Leukemia [abstract]. Blood 110:Abstract 587, 2007.
Hematology Am Soc Hematol Educ Program 2010:7, 2010. Huguet F, Leguay T, Raffoux E, et al: Pediatric-inspired therapy in adults
Gökbuget N, Kneba M, Raff T, et al: Adult patients with acute lympho- with Philadelphia chromosome-negative acute lymphoblastic leukemia:
blastic leukemia and molecular failure display a poor prognosis and are the GRAALL-2003 study. J Clin Oncol 27:911, 2009.
candidates for stem cell transplantation and targeted therapies. Blood Ribera JM, Oriol A, Sanz MA, et al: Comparison of the results of the treatment
120:1868, 2012. of adolescents and young adults with standard-risk acute lymphoblastic