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.
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Figueroa Camacho, J. L., Solano, M. H., & Villamizar Gómez, L. (2010). Treatment guidelines for acute lym phoblastic leukemia at hospital de San Jose, Bogota DC. Journal of Medicine and Surgery Repertoire, 19(3), 174–186. https://doi.org/10.31260/RepertMedCir.v19.n3.2010.596
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Abstract
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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References
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10. Rowe J, Goldstone A. How I treat acute lymphocytic leukemia in adults. Blood. 2007;110 (7): 2268-75.
11. Takeuchi J, Kyo T, Naito K, et al. Induction therapyby frequent admirústration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acule lymphoblastic leukemia:the JALSG ALL93 study. Leukemia. 2002;16 (7):1259-66.
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14. Kantarjian H, Thomas D, O'Brien S, et al.Long-term followup results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper CVAD), a dose-intensive regimen, in adult acule lymphocytic leukemia. Cancer. 2004;1O1:2788-801.
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18. Kantarjian H, O'Brien S, Smith TL, et al.Results of treatment with hyper CVAD, a dose-intensive regirnen, in adult acule lymphocytic leukemia. J Clin Oncol. 2000;18:547-61.
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26. Ribera J,OriolA, Bethencourt C et al. Comparison of intensive chemotherapy, allogeneic or autologous stem cell transplantation as post-remission treatrnent for adult patients with high-risk acule lymphoblastic leukemia. Results of the PETHEMAALL-93 trial. Haematologica.2005; 90:1346-56.
27. Orsi C, Bartolozzi B, MessoriA, BosiA.Event-freesurvival and cost-effectiveness in adult acule lymphoblastic leukaemia in first remission treated with allogeneic transplantation. Bone Marrow Transplant. 2007;40 (7): 643-9.
28. Stock W, La M, Sanford B et al.Adolescents and Yong adults with acute Jymphoblastic leukemia (ALL) have improved outcomes when treated on pediatric oncology cooperative group treatment regimens: a comparison of Children's Cancer Group (CCG) and Cancer and Leukemia Group B (CALGB) studies. Blood. 2008;112:1646-54.
29. Boissel N, Auclerc MF, Lhéritier V, et al. Should adolescents with acule lyrnphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. 2003;21:774-80.
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31. Rarnanujachar R, Richards S, Hann I, et al. Adolescents with acute lymphoblastic leukaemia: outcome on UK nacional paediatric(ALL97) and adult (UKALLXIJ/E2993) triaIs. Pediatr Blood Cancer.2007;48:254-61.
32. Hallboi:ik H, Gustafsson G, Smedmyr B, et al. Treatment outcome in young adults and children >1O years of age with acule lymphoblastic leukemia in Sweden: acompariciónbetween a pediatricprotocol and an adult protocol. Cancer. 2006;107:1551-61.
33. Ribera JM, Albert O, Miguel-Angel S, et al.Comparison of the results of the treatment of adolescents and young adults with standard-risk acule lymphoblastic leukemia with the Programa Espanol de Trata miento en Hematologia pediatricbased protocol ALL-96.J Clin Oncol. 2008;26:1843-9.
34. Faderl S, Kantarjian HM,Talpaz M, Estrov Z.Significance of cytogenetic abnormalities inadult acule lymphoblasticleukemia. Blood. 1998;9 I:3995- 4019.
35. Larson RA. Management of acule lymphoblastic leukemia in older patients. Semin Hematol. 2006;43:126-33.
36. Faderl S, Kantarjian H, Thomas DA eal. Outcome of Philadelphia chromosome-positive adult acule lymphoblastic leukemia.LeukLymphoma. 2000;36:263-73.
37. Walker l.Toe use of Imatinib Mesylate (gleevec) inpatients whith Philadelphia chromosome-positive adult acute lymphoblastic leucemia. Ontario: Cancer Care Ontario; 2008. Sep 29. Report No.: IO.
38. Thomas DA, Kantarjian HM, Cortes JE, Ravandi F, Faderl S, Jones D. Outcome after frontline therapy with the hyper CVAD and imatinib mesylate regirnen for adults with de novo or minimally treated Philadelphia (Ph) positive acule lymphoblastic leukemia (ALL). In: 2008ASCOAnnual Mee ting; 2008 May 30-Jun 3; Chicago, Illinois: ASCO.
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42. Delannoy A, Delabesse E, Lhéritier V, Castaigne S, Rigal-Huguet F, Raffoux E, et al. lmatinib and ethylprednisolone alternated with chemotherapy improve the outcome of elderly patients with Philadelphia-positive acute lymphoblastic leukemia: results of the GRAALLAFR09 study. Leukemia. 2006;20(9):1526-32.
43. Wassmann B, Pfeifer H, Scheuring UJ, BinckebanckA, Gokbuget N, Atta J, et al. Altemating versus concurrent schedules of imatinib and chemotherapy as front-line therapy for Philadelphia-positive acute lymphoblastic leukernia (Ph+ ALL). Blood. 2006;108(5): 1469-77.
44. Lee S, Kim Y-J, Min C-K, Kim H-J, Eom K-S, Kim D-W, et al. The effect of first-line imatinib interim therapy on the outcome of allogeneic stem cell transplantation in adults with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukernia. Blood. 2005; 105(9):3449-57.
45. Lee K-H, Lee J-H, Choi S-J, Lee J-H, Seol M, Lee Y-S, et al. Clinical effect of imatinib addedto intensive combination chemotherapy for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukernia. Leukemia. 2005;19(9):1509-16.
46. Carpenter PA, Snyder OS, Flowers MEO, Sanders JE, Gooley TA, Martín PJ, et al.Prophylactic administration of imatinib after hematopoietic cell transplantation for highrisk Philadelphia chromosome-positive leukemia. Blood. 2007;109(7):2791-3.
47. Vignetti M, Fazi P, Cimino G, Martinelli G, Di Raimondo F, Ferrara F, et al. Imatinib plus steroids induces complete rernissions and prolonged survival in elderly Philadelphia chromosome-positive patientswith acule lymphoblastic leukernia without additional chemotherapy: results of the Gruppo Italiano Malattie Ematologiche dell'Adulto(GIMEMA)LAL0201-Bprotocol. Blood. 2007;109(9):3676-8.
48. Rea D, Legras L, Raffoux E, Thomas X, Turlure P, Maury S, et al. High dose imatinib mesylate combinedwithvincristineand dexamethasone (DIV regimen) as induccióntherapyinpatientswith resistant Philadelphia-positive acute lymphoblastic leukernia and lymphoid blast crisis of chronic myeloid leukemia. Leukernia. 2006;20(3):400-3.
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2. Pui CH, Evans WE. Treatment ofacute lymphoblastic leukemia. N Engl J Med. 2006 Jan 12; 354(2): 166-78.
3. Gokbuget N, Hoelzer D. Treatment ofadult acule lymphoblastic leukemia. HematologyAm Soc Hematol Educ Program. 2006;133-41.
4. Hoeltzer D, GoKbuget N. Treatment ofadult acule lymphoblastic leukemia. Hematology. 2006;1: 162-92.
5. Enciso L, Rodríguez M, et al. Consensocolombiano sobre el tratamiento de la leucemia linfoblástica aguda en adultos. Rev Colomb Cancero! 2006;10(1):7-35.
6. Rowe J. How I treat acute Lymphoblastic Leukemia in Adults. Blood 2007;1!0(7): 2268-75
7. Scottish Intercollegiale Guideline Network. SIGN 50: a guideline developers' handbook. Edinburgh: SIGN; 2008.
8. TheAGREE Collaboration.Appraisal ofGuidelines for Research & Evaluation (AGREE) lnstrument. London: AGREE; 2003.
9. Hoelzer D, Gokbugel N. Treatment ofadull acule lymphoblastic leukemia. Semin Hematol. 2009;46(1):64-75.
10. Rowe J, Goldstone A. How I treat acute lymphocytic leukemia in adults. Blood. 2007;110 (7): 2268-75.
11. Takeuchi J, Kyo T, Naito K, et al. Induction therapyby frequent admirústration of doxorubicin with four other drugs, followed by intensive consolidation and maintenance therapy for adult acule lymphoblastic leukemia:the JALSG ALL93 study. Leukemia. 2002;16 (7):1259-66.
12. Rowe JM, Buck G, BumettAK, et al. Induction therapy for adults with acule lymphoblastic leukemia: results of more than 1500 patients from the international ALL tria!: MRC UKALL XII/ECOG E2993. Blood. 2005;106(12):3760-7.
13. Larson R, Dodge R, Linker C, et al. A randomized controlled tria! of filgrastim during remission induction and consolidation chemotherapy for adults with acule lymphoblastic leukemia: CALGB study 9111. Blood. 1998;92(5):1556-64.
14. Kantarjian H, Thomas D, O'Brien S, et al.Long-term followup results of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper CVAD), a dose-intensive regimen, in adult acule lymphocytic leukemia. Cancer. 2004;1O1:2788-801.
15. Gokbuget N, Arnold R, Buechner T, et al. Intensification of induction and consolidation improves only subgroups of adult ALL: Analysis of 1200 patients in GMALL study 05/93 [abstrae!].Blood.2001;98: 802.
16. Thomas X, Boiron JM, Huguet F, et al.Outcome of treatrnent in adults with acule lymphoblastic leukemia: analysis of the LALA-94 tria!. J Clin Oncol. 2004; 22:4075-86.
17. Mancirú M. An integrated molecular-cytogenetic classification is highly predictive of outcomein adult acute lymphoblastic leukemia (ALL): analysis of 395 cases enrolled in the GIMEMA 0496 trial. Blood.2001; 98:3492a.
18. Kantarjian H, O'Brien S, Smith TL, et al.Results of treatment with hyper CVAD, a dose-intensive regirnen, in adult acule lymphocytic leukemia. J Clin Oncol. 2000;18:547-61.
19. Combariza J, Casas C.Adult acule lymphoid leukemia survival in patients receiving treatrnent with HyperCVAD at the Instituto Nacional de Cancero logía (Colombia), January 2001 to June 2005. Rev Colomb Cancerol. 2007;11(2): 92-100.
20. Yanada M, Matsuo K. Allogenichematopoietic steam cell transplantation as part of postremission therapy improves survival for adult patients with high risk acute Lymphoblastic Leukemia. A metaanalisis. Cancer. 2006;106(12).
21. Sebban C, Lepage E, Vemant JP etal.Allogeneic bone marrow transplantation inadult acule lymphoblastic leucemia in first completeremission: a comparative study. French Group ofTherapy of Adult Acute Lymphoblastic Leukemia. J Clin Oncol. 1994;12(2580):2587.
22. Dombret H, Gabert J, Boiron JM et al. Outcome of treatment in adults with Philadelphia chromosome-positive acule lymphoblastic leukemia-results of the prospective multicenter LALA-94 trial. Blood. 2002; 100: 2357-66.
23. Thomas X, Boiron J, Huguet F et al. Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial. J Clin Oncol. 2004; 22:4075-86.
24. Hunault M, Harousseau JL, Delain M, et al. Better out come of adult acute lyrnphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial.Blood. 2004;104:3028-37.
25. Labar B, Suciu S, Zittoun R, et al. Allogeneic stem cell transplantación in acute lymphoblastic leukemia and non-Hodgkin's lymphoma for patients or 50 years old in first complete remission: results of the EORTC ALL-3 trial. Haematologica. 2004;89:809-17.
26. Ribera J,OriolA, Bethencourt C et al. Comparison of intensive chemotherapy, allogeneic or autologous stem cell transplantation as post-remission treatrnent for adult patients with high-risk acule lymphoblastic leukemia. Results of the PETHEMAALL-93 trial. Haematologica.2005; 90:1346-56.
27. Orsi C, Bartolozzi B, MessoriA, BosiA.Event-freesurvival and cost-effectiveness in adult acule lymphoblastic leukaemia in first remission treated with allogeneic transplantation. Bone Marrow Transplant. 2007;40 (7): 643-9.
28. Stock W, La M, Sanford B et al.Adolescents and Yong adults with acute Jymphoblastic leukemia (ALL) have improved outcomes when treated on pediatric oncology cooperative group treatment regimens: a comparison of Children's Cancer Group (CCG) and Cancer and Leukemia Group B (CALGB) studies. Blood. 2008;112:1646-54.
29. Boissel N, Auclerc MF, Lhéritier V, et al. Should adolescents with acule lyrnphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. 2003;21:774-80.
30. de Bont JM, Holt B, Dekker AW, et al. Sigrúficant difference in outcome for adolescents with acule lyrnphoblastic leucemia treated on pediatric vs adult protocols in the Netherlands. Leukemia. 2004;18:2032-5.
31. Rarnanujachar R, Richards S, Hann I, et al. Adolescents with acute lymphoblastic leukaemia: outcome on UK nacional paediatric(ALL97) and adult (UKALLXIJ/E2993) triaIs. Pediatr Blood Cancer.2007;48:254-61.
32. Hallboi:ik H, Gustafsson G, Smedmyr B, et al. Treatment outcome in young adults and children >1O years of age with acule lymphoblastic leukemia in Sweden: acompariciónbetween a pediatricprotocol and an adult protocol. Cancer. 2006;107:1551-61.
33. Ribera JM, Albert O, Miguel-Angel S, et al.Comparison of the results of the treatment of adolescents and young adults with standard-risk acule lymphoblastic leukemia with the Programa Espanol de Trata miento en Hematologia pediatricbased protocol ALL-96.J Clin Oncol. 2008;26:1843-9.
34. Faderl S, Kantarjian HM,Talpaz M, Estrov Z.Significance of cytogenetic abnormalities inadult acule lymphoblasticleukemia. Blood. 1998;9 I:3995- 4019.
35. Larson RA. Management of acule lymphoblastic leukemia in older patients. Semin Hematol. 2006;43:126-33.
36. Faderl S, Kantarjian H, Thomas DA eal. Outcome of Philadelphia chromosome-positive adult acule lymphoblastic leukemia.LeukLymphoma. 2000;36:263-73.
37. Walker l.Toe use of Imatinib Mesylate (gleevec) inpatients whith Philadelphia chromosome-positive adult acute lymphoblastic leucemia. Ontario: Cancer Care Ontario; 2008. Sep 29. Report No.: IO.
38. Thomas DA, Kantarjian HM, Cortes JE, Ravandi F, Faderl S, Jones D. Outcome after frontline therapy with the hyper CVAD and imatinib mesylate regirnen for adults with de novo or minimally treated Philadelphia (Ph) positive acule lymphoblastic leukemia (ALL). In: 2008ASCOAnnual Mee ting; 2008 May 30-Jun 3; Chicago, Illinois: ASCO.
39. Ribera JM, Oriol A, Gonzalez M, Vidriales M-B, Xicoy B, Grau J, et al. Treatment of Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) with concurren! chemotherapy and imatinib mesylate. In: Abstracts of the American Society of Hernatology 46th Annual Meeting; 2004 Dec. 4-7; California: ASH.
40. Fielding AK, Richards SM, Lazarus HM, Litzow MR, Luger SM, Marks DI, et al.Does imatinib change the outcome in Philadelphia chromosome positive acule lymphoblastic leukemia in adults? Data from the UKALLXII/ECOG2993 study.In: Abstracts of the American Society of Hematology 49th Annual Meeting; 2007 Dec. 8-11; Atlanta, Giorgia: ASH.
41. de Labarthe A, Rousselot P, Huget-Rigal F, Delabesse E, Witz F, Maury S, et al. Jmatinib combined with induction or consolidationchemotherapy in
lymphoblastic leukemia: results of the GRAAPH- 2003 study. Blood. 2007;109(4):1408-13.
42. Delannoy A, Delabesse E, Lhéritier V, Castaigne S, Rigal-Huguet F, Raffoux E, et al. lmatinib and ethylprednisolone alternated with chemotherapy improve the outcome of elderly patients with Philadelphia-positive acute lymphoblastic leukemia: results of the GRAALLAFR09 study. Leukemia. 2006;20(9):1526-32.
43. Wassmann B, Pfeifer H, Scheuring UJ, BinckebanckA, Gokbuget N, Atta J, et al. Altemating versus concurrent schedules of imatinib and chemotherapy as front-line therapy for Philadelphia-positive acute lymphoblastic leukernia (Ph+ ALL). Blood. 2006;108(5): 1469-77.
44. Lee S, Kim Y-J, Min C-K, Kim H-J, Eom K-S, Kim D-W, et al. The effect of first-line imatinib interim therapy on the outcome of allogeneic stem cell transplantation in adults with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukernia. Blood. 2005; 105(9):3449-57.
45. Lee K-H, Lee J-H, Choi S-J, Lee J-H, Seol M, Lee Y-S, et al. Clinical effect of imatinib addedto intensive combination chemotherapy for newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukernia. Leukemia. 2005;19(9):1509-16.
46. Carpenter PA, Snyder OS, Flowers MEO, Sanders JE, Gooley TA, Martín PJ, et al.Prophylactic administration of imatinib after hematopoietic cell transplantation for highrisk Philadelphia chromosome-positive leukemia. Blood. 2007;109(7):2791-3.
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