Outcome of 50 Iraqi Patientswith Acute Lymphoblastic Leukemia Treated by Modified German Multicenter Study Group (GMALL) Protocol | ||
| Mustansiriya Medical Journal | ||
| Article 1, Volume 12, Issue 2, December 2013, Pages 45-51 | ||
| Author | ||
| Alaa Fadhil Alwan | ||
| Abstract | ||
| Background and aim: Acute lymphoblastic leukemia (ALL) is a lymphoidmalignancy, which arises from bone marrow,appearing in marrow, blood circulation and otherorgans. Treatment outcome have significantly improved since the adaptation of intensification and risk adapted therapy-based on identified prognostic markers. Treatment programs in adult ALL have evolved from the successful strategies employed in pediatric ALL and incorporate multiple active agents into complex regimens. The goal of these doses intensive regimens is rapid cytoreduction with restoration of normal hematopoiesis, The aim of the study was to assess the efficacy of a modified German multicenter study group for Acute Lymphoblastic leukemia (GMALL) protocol in adult acute lymphoblastic leukemia (ALL( in respect to disease free survival (DFS) and overall survival(OS) and to determine the prognostic factors affecting this outcome. Patients and method: A prospective study conducted in the hematology unit in Baghdad Teaching Hospital on 50 patients with newly diagnosed (ALL) between January 2006 to January 2008.A written informed consent were obtained from all patients. All patients were undergone full clinical examination with full laboratory investigations. The diagnosis based on morphology and cytochemical stains (periodic acid-Schiff, Sudan Black) of bone marrow examination. In Modified GMALL, induction phase consist of 2 phases, phase 1 induction was given over 5 weeks with weekly vincristine (VCR), Doxorubicin(DOX), and continuous oral prednisolone(RDN), Phase II induction consisted of 3 doses of weekly cyclophosphamide(CYCLO) alternating with 3 doses of weekly cytosine arabinoside (ARA-C) combined with CNS directed therapy using intrathecal Methotrexate (MTX) with daily 6-mercaptopurine(6-MP) followed by cranial irradiation. Consolidation consisted of weekly VCR and two courses of 5 days Ara-C and Etoposide (ETOP) with dexamethasone (DEXA) over a period of 4 weeks and maintenance therapy of daily 6-MP tablets and weekly MTX tablets. Results: The study included 50 patients with median age of (28.5 years), ranged from 16-71 years. Thirty-one patients (62%) were males, while 19 patients (38%) were females. All patients received modified GMALL protocol; forty-two patients (84%) achieved complete remission (CR). The DFS and median OS were 8.5 months, 10 months respectively. The median OS at 1 year was 54%. Deaths occurred in 19 patients (38%). Infection was the main cause of death.In univariate study analysis, age less than 30 years, absence of hepatomegaly and lymphadenopathy, and peripheral blast percent less than 50% were associated with better OS while presence of lymphadenopathy was considered poor prognostic factors and associated with low CR rate, short DFS, and OS. Conclusion: The modified GMALL protocol produced good induction remission rate but with lower survival rate in comparison to other intensive adult protocols. This study also showed that there are certain bad prognostic factors such as age more than 30 years, hepatomegaly and lymphadenopathy which adversely affect the outcome | ||
| Keywords | ||
| Outcome; treatment; acute lymphoblastic leukemia | ||
|
Statistics Article View: 12 |
||