Published online 9 February 2010
Haematologica, Vol 95, Issue 4, 589-596 doi:10.3324/haematol.2009.014274
Copyright © 2010 by Ferrata Storti Foundation
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Acute Lymphoblastic Leukemia

Outcome after relapse of acute lymphoblastic leukemia in adult patients included in four consecutive risk-adapted trials by the PETHEMA Study Group

Albert Oriol1, Susana Vives1, Jesús-María Hernández-Rivas2, Mar Tormo3, Inmaculada Heras4, Concepción Rivas5, Concepción Bethencourt6, Federico Moscardó7, Javier Bueno8, Carlos Grande9, Eloy del Potro10, Ramon Guardia11, Salut Brunet12, Juan Bergua13, Teresa Bernal14, Maria-José Moreno15, Carlota Calvo16, Pilar Bastida17, Evarist Feliu1, Josep-Maria Ribera1 for the Programa Español de Tratamiento en Hematologia (PETHEMA) Group

1 Servei d’Hematologia Clínica, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
2 Hospital Clínico Universitario, Salamanca
3 Hospital Clínico Universitario, Valencia
4 Hospital Morales Meseguer, Murcia
5 Hospital General, Alicante
6 Hospital Universitario Carlos Haya, Málaga
7 Hospital La Fe, Valencia
8 Hospital de la Vall d’Hebron, Barcelona
9 Hospital Doce de Octubre, Madrid
10 Hospital Clínico San Carlos, Madrid
11 Hospital Josep Trueta, Girona
12 Hospital de Sant Pau, Barcelona
13 Hospital San Pedro de Alcántara, Cáceres
14 Hospital Central de Asturias, Oviedo
15 Hospital Virgen de la Victoria, Málaga
16 Hospital Miguel Servet, Zaragoza and
17 Hospital Materno-Infantil de la Vall d’Hebron, Barcelona, Spain

Correspondence: Albert Oriol, Servei d’Hematologia Clínica, Institut Català d’Oncologia, Hospital Germans Trias i Pujol, Ctra. Del Canyet s/n 08916 Badalona, Barcelona, Spain. E-mail: aoriol{at}iconcologia.net

Background: About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia.

Design and Methods: We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials.

Results: The median overall survival after relapse was 4.5 months (95% CI, 4–5 months) with a 5-year overall survival of 10% (95% CI, 8%–12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%–30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%–53%) and a 5-year disease-free survival of 53% (95% CI, 34%–72%).

Conclusions: The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.

Key words: acute lymphoblastic leukemia, relapse, rescue treatment, prognostic factors.