Efficacy of an intensive post-induction chemotherapy regimen for adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia,given predominantly in the out-patient setting

Intensification of chemotherapy in adults with acute lymphoblastic leukemia (ALL) has improved outcome. The aim of this analysis was to evaluate outcome of patients treated with an intensive regimen based on that used in the German national trials, but adapted in order to enable treatment to be given mainly on an out-patient basis, once complete remission (CR) had been achieved. Between 2000 and 2007, 53 patients with Philadelphia chromosome-negative ALL (40 with B-ALL and 13, T-ALL) received treatment. CR was achieved in 47/53 (89%), with no significant difference in CR rate between B- and T-ALL. At a median follow-up of 6.3 years, 25 patients are alive, 23 (43%) in 1st CR, and 20 have relapsed. No patient died in CR due to treatment-related toxicity. At 5 years, overall survival was 50%, and disease-free survival, 53%. Thirty four of the 47 patients in whom CR was achieved completed therapy and are evaluable for duration of hospital stay and number of Day Unit attendances. The median time in hospital during the year of treatment was 10 weeks (range, 6–44) with no significant difference between patients ≤ vs. >30 years old. It was possible to administer this intensive protocol largely on an out-patient basis without compromising patient safety.