Treatment guidelines for acute lym phoblastic leukemia at hospital de San Jose, Bogota DC.

Guía de manejo para el tratamiento de la Leucemia linfoide aguda hospital de San José, Bogotá D.C.

Treatment regimes for acote lymphoblastic leukemia (ALL) show complete remission rates of 70  and  90  percent but poor long-term results and 5-year disease-free survival rates of 30 to 40 percent. Designing treatment guidelines for our institution is justified by the existence of multiple protocols worldwide, various clinical responses, controversy on thcrapeutic options and difficulty to adapt treatmcnt strategies in our country. We conducted a systematic literature search on adult ALL treatment. Childhood and progenitor T-cell ALL were excluded. We found 335 articles and selected 48 which met the inclusion criteria. Objective: to establish therapeutic strategies for adult ALL based on available evidence and adapting them to our institutional resources. Materials and Methods: the broaden review was based on the assessment of secondary trials such as clinical practice guides, meta-analyses and systematic reviews published between January 2005 and February 2009, or the review of clinical trials. The analyzed databases included PubMed, Medline, Clinical Evidence, Cochrane, as well as 34 compilation bases. Conclusions: 1) The largest series conclude that induction phase treatment for adult ALL must include corticosteroid, antracyclines, vincristine and L-asparaginase, including central nervous system prophylaxis. 2) Treatment of adolescents  and  young  adults must be based on pediatric protocols but there is not enough evidence as to accept one standard  protocol. 3) 400 and 800 mg/day imatinib is indicated for all Ph-positive ALL patients from the treatment induction phase up to treatment completion. Benefit is greater when it is given from the induction phase combined with chemotherapy than when administered sequentially. 4) Regimes consistent with high-intensity chemotherapy plus imatinib and consolidated with allogenic transplantation during the first complete remission have shown the best long-term · results and constitute the standard therapy. 5) Monitoring of minimal residual Ph-positive ALL is recommended after allogenic transplantation for it constitutes a relapse predictor. 6) There are no available comparative randomized controlled trials which assess the impact of imatinib on a minimal residual disease (MRD) and are difficult to conduct due to low incidence. Wassmann et al., suggest there is a long-term benefit on patients who achieve complete early molecular response with imatinib.

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