TY - JOUR
T1 - Long-term follow-up results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD), a dose-intensive regimen, in adult acute lymphocytic leukemia
AU - Kantarjian, Hagop
AU - Thomas, Deborah
AU - O'Brien, Susan
AU - Cortes, Jorge
AU - Giles, Francis
AU - Jeha, Sima
AU - Bueso-Ramos, Carlos E.
AU - Pierce, Sherry
AU - Shan, Jianqin
AU - Koller, Charles
AU - Beran, Miloslav
AU - Keating, Michael
AU - Freireich, Emil J.
PY - 2004/12/15
Y1 - 2004/12/15
N2 - BACKGROUND. Modern intensive chemotherapy regimens have improved the prognosis for patients with adult acute lymphocytic leukemia (ALL). With these regimens, the complete response rates are now reported to be > 80%, and the long-term survival rates range from 30% to 45%. The current analysis updated the long-term results with the original hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD) program, with a median follow-up time of 63 months. METHODS. Between 1992 and 2000, 288 patients were treated with Hyper-CVAD. The median age of the patients was 40 years, and 59 patients (20%) were ≥ age 60 years. The incidence of Philadelphia chromosome (Ph)-positive ALL was 17%, and the incidence of of T-cell ALL was 13%. RESULTS. A complete response (CR) was achieved in 92% of patients. The induction mortality rate was 5% (2% if the patient's age was < 60 years, and 15% if the patient's age was ≥ 60 years). With a median follow-up time of 63 months, the 5-year survival rate was 38% and the 5-year CR duration rate was 38%. Multivariate analysis of prognostic factors for CR duration identified the following adverse factors: age ≥ 45 years, leukocytosis ≥ 50 × 109/L, poor performance status (an Eastern Cooperative Oncology Group score of 3-4), Ph-positive disease, French-American-British L2 morphology, > 1 course to achieve CR, and Day 14 bone marrow blasts > 5%. Patients were divided into low-risk (risk score 0-1; 37%), intermediate risk (risk score 2-3; 36%), and poor-risk groups (risk score ≥ 4; 27%) with 5-year CR duration rates of 52%, 37%, and 10%, respectively. CONCLUSIONS. Compared with the previous VAD regimens, Hyper-CVAD was associated with significantly better CR rates, CR duration, and survival. The long-term follow-up results of Hyper-CVAD were favorable. Comparison of Hyper-CVAD with other established adult ALL regimens is warranted.
AB - BACKGROUND. Modern intensive chemotherapy regimens have improved the prognosis for patients with adult acute lymphocytic leukemia (ALL). With these regimens, the complete response rates are now reported to be > 80%, and the long-term survival rates range from 30% to 45%. The current analysis updated the long-term results with the original hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper-CVAD) program, with a median follow-up time of 63 months. METHODS. Between 1992 and 2000, 288 patients were treated with Hyper-CVAD. The median age of the patients was 40 years, and 59 patients (20%) were ≥ age 60 years. The incidence of Philadelphia chromosome (Ph)-positive ALL was 17%, and the incidence of of T-cell ALL was 13%. RESULTS. A complete response (CR) was achieved in 92% of patients. The induction mortality rate was 5% (2% if the patient's age was < 60 years, and 15% if the patient's age was ≥ 60 years). With a median follow-up time of 63 months, the 5-year survival rate was 38% and the 5-year CR duration rate was 38%. Multivariate analysis of prognostic factors for CR duration identified the following adverse factors: age ≥ 45 years, leukocytosis ≥ 50 × 109/L, poor performance status (an Eastern Cooperative Oncology Group score of 3-4), Ph-positive disease, French-American-British L2 morphology, > 1 course to achieve CR, and Day 14 bone marrow blasts > 5%. Patients were divided into low-risk (risk score 0-1; 37%), intermediate risk (risk score 2-3; 36%), and poor-risk groups (risk score ≥ 4; 27%) with 5-year CR duration rates of 52%, 37%, and 10%, respectively. CONCLUSIONS. Compared with the previous VAD regimens, Hyper-CVAD was associated with significantly better CR rates, CR duration, and survival. The long-term follow-up results of Hyper-CVAD were favorable. Comparison of Hyper-CVAD with other established adult ALL regimens is warranted.
KW - Acute lymphocytic leukemia (ALL)
KW - And dexamethasone (Hyper-CVAD) regimen
KW - Doxorubicin
KW - Hyperfractionated cyclophosphamide
KW - Long-term follow-up
KW - Vincristine
UR - http://www.scopus.com/inward/record.url?scp=10044259800&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=10044259800&partnerID=8YFLogxK
U2 - 10.1002/cncr.20668
DO - 10.1002/cncr.20668
M3 - Article
C2 - 15481055
AN - SCOPUS:10044259800
SN - 0008-543X
VL - 101
SP - 2788
EP - 2801
JO - cancer
JF - cancer
IS - 12
ER -
