Similar Incidence of Typhlitis in Patients Receiving Various Doses of Daunorubicin or Idarubicin As Induction for Acute Myeloid Leukemia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3725-3725
Author(s):  
Amanda N Seddon ◽  
Angela G Michael ◽  
Nelly G. Adel ◽  
Martin S. Tallman ◽  
Oguz Akin ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Conflicts Of Interest ◽  
Standard Of Care ◽  
Adult Patients ◽  
Cell Transplant ◽  
Current Standard ◽  
Ileocecal Region ◽  
Concomitant Infection ◽  
Potential Factors ◽  
Definition Of

Abstract Background: The current standard of care for the treatment of patients with newly diagnosed AML is an anthracycline plus cytarabine. Both anthracyclines and cytarabine have been associated with the development of typhlitis, a serious adverse event characterized by inflammation of the bowel wall in patients with profound neutropenia, diagnosed via abdominal CT imaging and clinical symptoms. Given the paucity of available data, the aim of our study was to determine the incidence of typhlitis among AML patients receiving induction with either idarubicin 12 mg/m2 (IDA), daunorubicin 60 mg/m2 (DNA60), or daunorubicin 90 mg/m2 (DNA90). Methods: Adult patients with AML or MDS receiving either daunorubicin or idarubicin along with cytarabine as part of their induction regimen between 1/1/2009 and 6/30/2013 were included. A definition of typhlitis required CT confirmation of inflammation of the cecum, according to CTCAE version 4.03 along with clinical symptoms. Two radiologists (OA, JC) blinded to the treatment and outcomes independently reviewed CT scans. Two additional definitions including inflammation of the ileocecal region only and enterocolitis were also evaluated. All statistical analyses were performed on SAS software version 9.3. P values were calculated using Fisher Exact and Wilcoxon tests. Inter-rater reliability was assessed with Cohen’s Kappa. Results: Baseline characteristics were similar among the 3 treatment groups with the exception of age. The median age was lower in the DNA90 arm (79 years, 74 years, and 49 years in the IDA group, DNA60 group, and DNA90 group, respectively). A pre-existing GI disorder was reported in 24.1% IDA, 25.7% DNA60, and 22.4% DNA90 patients. Of the 202 total patients, the two radiologists determined that 40 (20%) and 38 (19%) developed typhlitis, based on the predefined standard. Tables 1 and 2 illustrate the relationship between treatment arm and associated incidence of typhlitis. The incidence in each treatment group did not statistically differ (p=0.23 and p=0.29). When the definition was broadened to include ileocecal region and enterocolitis, the incidence increased (Tables 1 and 2). The inter-reliability ratings of the 2 radiologists’ evaluations for each definition indicated substantial agreement (0.803 cecum, 0.834 ileocecal region only, and 0.752 enterocolitis). Neither the anthracycline chosen, nor the dose had a statistically significant impact on the incidence of typhlitis. Of all patient and treatment specific risk factors assessed for association with development of typhlitis (pre-existing GI disorder, rheumatologic disorder or cancer, prior RT, stem cell transplant or anthracycline exposure, cytarabine regimen or AML risk group), none were found to be statistically significant. In patients that developed typhlitis, approximately 56% and 51% had a concurrent documented infection around the typhlitis episode (Tables 1-2). Conclusion: To our knowledge, this is the first study to compare the incidence of typhlitis in adult patients receiving idarubicin or daunorubicin for the treatment of AML. While the cumulative incidence of typhlitis was higher than in published literature, the incidence was similar irrespective of the anthracycline chosen or dose. Of the potential factors that may have contributed to the development of typhlitis, none were significantly associated with typhlitis. All patients were managed conservatively with broad-spectrum antibiotics. A more definitive definition of typhlitis may help clinicians identify affected patients sooner and choose appropriate targeted therapy. Abstract 3725. Table 1. Association of treatment to Radiologist 1-rated typhlitis Enterocolitis Ileocecal region only Cecum No Yes P No Yes P No Yes P Treatment 0.52 0.68 0.23 DNA60 58 (78%) 16 (22%) 58 (78%) 16 (22%) 61 (82%) 13 (18%) DNA90 34 (69%) 15 (31%) 35 (71%) 14 (29%) 35 (71%) 14 (29%) IDA 58 (73%) 21 (27%) 60 (76%) 19 (24%) 66 (84%) 13 (16%) Concomitant infection Yes 11 (26%) 32 (74%) 13 (30%) 30 (70%) 19 (44%) 24 (56%) Abstract 3725. Table 2. Association of treatment to Radiologist 2-rated typhlitis Enterocolitis Ileocecal region only Cecum No Yes P No Yes P No Yes P Treatment 0.86 0.98 0.29 DNA60 57 (77%) 17 (23%) 57 (77%) 17 (23%) 62 (84%) 12(16%) DNA90 36 (73%) 13 (27%) 37 (76%) 12 (24%) 36 (73%) 13 (27%) IDA 58 (73%) 21 (27%) 61 (77%) 18 (23%) 66 (84%) 13 (16%) Concomitant infection Yes 11 (26%) 32 (74%) 13 (30%) 30 (70%) 21 (49%) 22 (51%) Disclosures No relevant conflicts of interest to declare.

Barriers to Reduced-Intensity Conditioning (RIC) Transplant in Patients with Chronic Lymphocytic Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1374-1374
Author(s):  
Samantha M. Jaglowski ◽  
Thomas S. Lin ◽  
Patrick Elder ◽  
Diane Scholl ◽  
John C. Byrd ◽  
...  
Keyword(s):  
Stem Cell ◽  
Conflicts Of Interest ◽  
Therapeutic Option ◽  
Lymphocytic Leukemia ◽  
Standards Of Care ◽  
Cell Transplant ◽  
Reduced Intensity Conditioning ◽  
Current Standard ◽  
Transplant Evaluation ◽  
Reduced Intensity

Abstract Abstract 1374 Poster Board I-396 Introduction: Allogeneic stem cell transplantation is the only potentially curative therapeutic option for patients with CLL. However, in spite of recent improvements in transplant-related mortality due to the introduction of reduced-intensity conditioning (RIC), only a proportion of patients go on to receive a stem cell transplant. The aim of this study was to quantify how many patients are evaluated for transplant versus how many go on to transplant, and to examine the reasons why transplantation was not performed. Patients and methods: A list of all patients with CLL who have been referred to the Ohio State University for a transplant evaluation from January 2003 to the present was obtained. Two electronic databases, E-Results and TransChart, were reviewed to determine if a consultation was performed, if patients were subsequently transplanted, and if not, why. Results: The outcomes of the referrals are summarized in Table 1. From January 2003 to the present, 205 patients with CLL were referred to our center for a transplant evaluation. Of those, 34 (16.6%) underwent transplantation. For patients who did not receive a transplant, it was not indicated at the time of consult according to current standard of care in 37 patients (18%), and in 29 (14.1%), transplant was indicated but patients were unable to obtain a remission in order to proceed. The differences between patients who went on to transplant and those who could not obtain remission were analyzed more closely. The median age in the transplant group was 55, and the median age in the group that could not obtain remission was 58. Both groups received a median 2 lines of treatment prior to transplant evaluation. The cytogenetic abnormalities of the groups are summarized in Table 2. Conclusions: The majority of patients who did not undergo transplantation did not have an indication for transplant, reflecting previous standards of care prior to the understanding of the poor prognosis of patients with high risk karyotype and fludarabine-refractory CLL. In contradistinction, an inability to obtain a remission in order to proceed to transplantation was the second most common reason transplantation was deferred. These data reflect the difficulty in some cases of determining the appropriate timing for allogeneic transplantation in CLL and the risk of delaying a transplant referral in patients with fludarabine refractory disease. Appropriate timing of transplant referral and choice of effective salvage therapy are critical to the successful long-term management of patients with fludarabine-refractory CLL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Moving Beyond Gleason Scoring

2019 ◽  
Vol 143 (5) ◽  
pp. 565-570 ◽  
Author(s):  
Brian Miles ◽  
Michael Ittmann ◽  
Thomas Wheeler ◽  
Mohammad Sayeeduddin ◽  
Antonio Cubilla ◽  
...  
Keyword(s):  
Biochemical Recurrence ◽  
Host Response ◽  
Cancer Survival ◽  
Predictive Ability ◽  
Standard Of Care ◽  
Molecular Data ◽  
Current Standard ◽  
Reactive Stroma ◽  
Response Measures ◽  
Definition Of

Context.— The combination of grading and staging is the basis of current standard of care for prediction for most cancers. D. F. Gleason created the current prostate cancer (PCa) grading system. This system has been modified several times. Molecular data have been added. Currently, all grading systems are cancer-cell based. Objective.— To review the literature available on host response measures as reactive stroma grading and stromogenic carcinoma, and their predictive ability for PCa biochemical recurrence and PCa-specific death. Data Sources.— Our own experience has shown that reactive stroma grading and the subsequently binarized system (stromogenic carcinoma) can independently predict biochemical recurrence and/or PCa-specific death, particularly in patients with a Gleason score of 6 or 7. Stromogenic carcinoma has been validated by 4 other independent groups in at least 3 continents. Conclusions.— Broders grading and Dukes staging have been combined to form the most powerful prognostic tools in standard of care. The time has come for us to incorporate measures of host response (stromogenic carcinoma) into the arsenal of elements we use to predict cancer survival, without abandoning what we know works. These data also suggest that our current definition of PCa might need some revision.

Childhood Myelodysplastic Syndrome: Focus on the Approach to Diagnosis and Treatment of Juvenile Myelomonocytic Leukemia

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 357-362 ◽  
Author(s):  
Mignon L. Loh
Keyword(s):  
Germ Line ◽  
Myeloproliferative Neoplasms ◽  
Standard Of Care ◽  
Mitogen Activated Protein Kinase ◽  
Juvenile Myelomonocytic Leukemia ◽  
Cell Transplant ◽  
Current Standard ◽  
Hematopoietic Stem ◽  
Mitogen Activated Protein ◽  
Myelomonocytic Leukemia

AbstractExpansion of myeloid blasts with suppression of normal hematopoiesis is a hallmark of acute myeloid leukemia (AML). In contrast, myeloproliferative neoplasms (MPNs) are clonal disorders characterized by overproliferation of one or more lineages that retain the ability to differentiate. Juvenile myelomonocytic leukemia (JMML) is an aggressive MPN of childhood that is clinically characterized by the overproduction of monocytic cells that can infiltrate organs, including the spleen, liver, gastrointestinal tract, and lung. Major progress in understanding the pathogenesis of JMML has been achieved by mapping out the genetic lesions that occur in patients. The spectrum of mutations described thus far in JMML occur in genes that encode proteins that signal through the Ras/mitogen-activated protein kinase (MAPK) pathways, thus providing potential new opportunities for both diagnosis and therapy. These genes include NF1, NRAS, KRAS, PTPN11, and, most recently, CBL. While the current standard of care for patients with JMML relies on allogeneic hematopoietic stem-cell transplant, relapse is the most frequent cause of treatment failure. Rarely, spontaneous resolution of this disorder can occur but is unpredictable. This review is focused on the genetic abnormalities that occur in JMML, with particular attention to germ-line predisposition syndromes associated with the disorder. Current approaches to therapy are also discussed.

scholarly journals Haematopoietic Stem Cell Transplant for Norovirus-Induced Intestinal Failure in X-linked Agammaglobulinemia

2021 ◽  
Author(s):  
Ben M. J. Shillitoe ◽  
Mark Ponsford ◽  
Mary A. Slatter ◽  
Jennifer Evans ◽  
Siske Struik ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Intestinal Failure ◽  
Standard Of Care ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Current Standard ◽  
Humoral Immunodeficiency ◽  
Bruton Tyrosine Kinase ◽  
Clinical Description

AbstractSince the first clinical description in 1952, immunoglobulin replacement therapy remains the mainstay of treatment of patients with X-linked agammaglobulinemia (XLA). However, this therapy only replaces IgG isotype and does not compensate for the loss of Bruton tyrosine kinase in non-B-lymphocytes. Patients may still therefore develop complications despite current standard of care. Here, we describe an XLA patient with persistent chronic norovirus infection, refractory to treatment and causing intestinal failure. The patient underwent haematopoietic stem cell transplantation, curing XLA and allowed clearance of norovirus prior to humoral immunoreconstitution, suggesting non-humoral immunodeficiency in these patients.

Prophylactic Use of Enoxaparin in Morbidly Obese Adolescents During Bariatric Surgery

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4367-4367
Author(s):  
Alvina Mushtaq ◽  
Janelle D Vaughns ◽  
Nicole Verdun ◽  
Elaine Williams ◽  
Victoria Ziesenitz ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Standard Of Care ◽  
Morbidly Obese ◽  
Extensive Literature ◽  
Current Standard ◽  
Obese Adolescents ◽  
Vte Prophylaxis ◽  
National Medical

Abstract Abstract 4367 Introduction: Obesity has increased exponentially in recent years and currently a substantial number of children and adolescents are morbidly obese. This development has resulted in the need for bariatric surgery in adolescents. Therefore, a bariatric surgery program has been initiated at Children's National Medical Center (CNMC) and enoxaparin has been used as prophylaxis for venous thromboembolism (VTE). Enoxaparin is the drug of choice for prevention and treatment of VTE in children and adults. The standard of care at CNMC is to dose enoxaparin 40 mg SC q 12 hrs in patients with a BMI < 50 and 60 mg SC q 12 hrs for patients with a BMI > 50 with no routine use of anti-FXa monitoring. Nationally and internationally there are no well defined guidelines for prophylactic doses of enoxaparin and the approach varies among different institutions. This study was therefore designed and conducted to investigate if the current dosing regimens are indeed appropriate. Patients and Methods: Four morbidly obese adolescents aged 16 to 18 years and with a body weight ranging between 118 and 174 kg were studied. Anti-FXa assay concentrations were collected before (predose) and at 1, 2, 4, 6, and 12 hrs after the administration of the first dose of enoxaparin. In addition, after an extensive literature search, two pharmacokinetic (PK) studies were found that investigated comparable doses of enoxaparin in adult lean healthy volunteers with a mean age of 24 years. Results: The results are shown in Figure 1 and Table 1. The peak anti-FXa level (Cmax) ranged from 0.2–0.23 IU/ml in the 4 studied adolescents and these values are significantly lower as compared to the range of concentrations (0.38–0.5 IU/ml) detected in the two control groups from the literature. The time to reach Cmax (T max) was delayed, along with a lower area under the time vs concentration curve and the mean residence time. Conclusions: We conclude, based on our results, that the use of 40–60 mg enoxaparin as the current standard of care for VTE prophylaxis in morbidly obese adolescents results in different and probably insufficient anti-FXa levels as compared to those found in lean patients of comparable age. The clinical significance of this finding still needs to be determined. Disclosures: No relevant conflicts of interest to declare.

scholarly journals What is a clinically meaningful survival benefit in refractory metastatic colorectal cancer?

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Y. J. Ko ◽  
M. Abdelsalam ◽  
P. Kavan ◽  
H. Lim ◽  
P. A. Tang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Clinical Benefit ◽  
Policy Decision ◽  
Standard Of Care ◽  
Current Standard ◽  
Cancer Treatments ◽  
Medical Oncologists ◽  
Definition Of

Assessment of the clinical benefit of cancer treatments can be highly subjective, influenced by both perspective and context. Such assessments are required in regulatory and policy decision-making, but consistency between jurisdictions is often lacking. Clear and consistent standards for determining when a treatment offers a meaningful benefit, relative to the current standard of care, can help to address issues of equity and transparency in health technology assessment.    For metastatic colorectal cancer (mcrc), no standardized Canadian definition of clinically meaningful benefit has yet been proposed. Colorectal Cancer Canada therefore convened a group of medical oncologists expert in colorectal cancer to review the literature about clinical significance. The resulting consensus is intended to apply to any therapeutic agent being considered in the setting of chemotherapy-refractory mcrc.    It was agreed that overall survival is the appropriate measure of clinical efficacy in chemorefractory mcrc. As quantitative targets for efficacy, an improvement of 2 months or more in median overall survival or a hazard ratio for survival of 0.75 or lower (or both) are proposed as the threshold for clinically meaningful benefit. That threshold could be influenced by a treatment’s effect on quality of life. Treatment toxicity is also relevant to the assessment of clinical benefit in this setting, specifically when significant differences in treatment tolerability are evident.

scholarly journals Therapeutic targeting of FLT3 and associated drug resistance in acute myeloid leukemia

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Melat T. Gebru ◽  
Hong-Gang Wang
Keyword(s):  
Drug Resistance ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Molecular Mechanisms ◽  
Gene Mutations ◽  
Standard Of Care ◽  
Cell Transplant ◽  
Current Standard ◽  
Hematopoietic Stem ◽  
Acute Myeloid

AbstractAcute myeloid leukemia (AML) is a heterogeneous disease caused by several gene mutations and cytogenetic abnormalities affecting differentiation and proliferation of myeloid lineage cells. FLT3 is a receptor tyrosine kinase commonly overexpressed or mutated, and its mutations are associated with poor prognosis in AML. Although aggressive chemotherapy often followed by hematopoietic stem cell transplant is the current standard of care, the recent approval of FLT3-targeted drugs is revolutionizing AML treatment that had remained unchanged since the 1970s. However, despite the dramatic clinical response to targeted agents, such as FLT3 inhibitors, remission is almost invariably short-lived and ensued by relapse and drug resistance. Hence, there is an urgent need to understand the molecular mechanisms driving drug resistance in order to prevent relapse. In this review, we discuss FLT3 as a target and highlight current understanding of FLT3 inhibitor resistance.

scholarly journals How I treat the young patient with multiple myeloma

Blood ◽  
2018 ◽  
Vol 132 (11) ◽  
pp. 1114-1124 ◽  
Author(s):  
Sara Gandolfi ◽  
Claudia Paba Prada ◽  
Paul G. Richardson
Keyword(s):  
Multiple Myeloma ◽  
Residual Disease ◽  
Proteasome Inhibitors ◽  
High Sensitivity ◽  
Standard Of Care ◽  
Autologous Stem Cell Transplant ◽  
Novel Agents ◽  
Cell Transplant ◽  
Current Standard ◽  
Disease Biology

Abstract The treatment landscape for multiple myeloma has been transformed by the introduction of novel agents, including immunomodulatory drugs, proteasome inhibitors, and monoclonal antibodies. These have been shown to be more effective and generally better tolerated than conventional chemotherapy, with their introduction into clinical practice leading to improved survival. Furthermore, a better understanding of disease biology, improved diagnostic criteria, and the development of sensitive and specific tools for disease prognostication have contributed to better outcome. Treatment in the younger patient can now be individualized based on host and disease features with enhanced monitoring of response and use of high-sensitivity techniques for evaluating residual disease. The current standard of care has been significantly enhanced by novel agents with a paradigm shift toward optional or delayed autologous stem cell transplant as a reasonable choice in selected patients. Conversely, extended treatment with induction of remission followed by maintenance strategies is now a standard of care, conferring prolonged disease control with more manageable toxicities in both the short and long term, as well as improved quality of life.

scholarly journals Persistent Mixed Donor Chimerism following Double Umbilical Cord Transplantation in a Patient with T-Cell Prolymphocytic Leukemia

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Ronak H. Mistry ◽  
Elizabeth O. Hexner ◽  
James K. Mangan
Keyword(s):  
T Cell ◽  
Umbilical Cord ◽  
Cord Blood Transplantation ◽  
Standard Of Care ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Current Standard ◽  
T Cell Therapy ◽  
Prolymphocytic Leukemia ◽  
Blood Transplantation

T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive postthymic T-cell neoplasm with an associated survival time of 1 year when left untreated. Current standard of care for T-PLL is with alemtuzumab, followed by allogeneic or autologous stem cell transplant. Little is found in the literature about alternative donor transplantation in T-PLL. Here, we present the case of a patient treated with double umbilical cord blood transplantation, which resulted in initial complete remission. An unusual outcome of this case is that coengraftment of both cords was established. After 16 months, the patient had relapse of the disease, unfortunately, prompting treatment with alemtuzumab and pentostatin, which resulted in remission once again. Here, we report a unique phenomenon whereby single-cord dominance occurred after treatment with these agents, suggesting that anti-T-cell therapy after transplant may help achieve single-unit dominance. A second relapse of the disease occurred six months thereafter, ultimately resulting in the patient’s death, highlighting the aggressive nature of this disease.

MECp, a Salvage Regimen with Drugs Not Employed as Frontline Therapy, Allowed to Obtain a High CR Rate and to Bring to Unrelated Allogeneic Transplantation a High Proportion of Adult Patients with Relapsed ALL.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4101-4101
Author(s):  
Erika Borlenghi ◽  
Elisa Cerqui ◽  
Chiara Cattaneo ◽  
Francesco Zuccalà ◽  
Piero Galbiati ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Adult Patients ◽  
Haematopoietic Stem Cell ◽  
High Dose ◽  
Cell Transplant ◽  
First Line ◽  
Salvage Regimen ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy

Abstract Abstract 4101 Background and aim The only curative option for adult patients with refractory or relapsed ALL is allogeneic haematopoietic stem cell transplant (allo-HSCT), which can offer a 28-34% long term survival in transplanted patients. However the actual feasibility of allo-HSCT is only 20-30% in unselected patients because of the low rate (30-50%) of complete remission (CR) achieved with salvage regimens (Tavernier, 2007- Thomas, 1999), the high rate of early relapse (Martino, 1999) and the difficulties in finding a suitable donor before progression (Davies, 1996). Hence, relapsed ALL can be actually cured in less than 10% of unselected adult patients. Using a second line treatment capable of obtaining a higher proportion of CR of longer duration may improve the dismal overall prognosis of patients. We report on the efficacy and toxicity profile of the combination of 6-metilprednisolone, mitoxantrone, etoposide and high-dose cytarabine (MECp), a salvage regimen containing cytostatic drugs to which patients had not been exposed during first line therapy, except for cytarabine at lower doses. Patients and Methods Between October 2000 and May 2009, 18 refractory/relapsed ALL patients were treated at our Institution with MECp regimen, consisting of a single course of etoposide 80mg/mq/die iv, cytarabine 1000mg/mq/die iv for 6 hours and mitoxantrone 6mg/mq/die iv 9 hours after cytarabine infusion for 6 days associated to metilprednisolone 50 mg/mq/die for 21 days, subsequently tapered to zero over one week. Three patients received an experimental sequential pulsed chemotherapy program in a multiinstitutional setting. At diagnosis, all patients had been treated according to the NILG-ALL 00/09 program (Bassan, Blood 2009). Four had been refractory to induction therapy and 14 had relapsed after a median of 12 months (range 3-43), 11 while on consolidation/maintenance, one after allo-HSCT, two after 3 and 12 months from the end of maintenance. There were 10 males and 8 females with a median age of 28 (range 17-64). ALL lineage was B in 9 cases (4 pro-B, 4 common, 1 pre B), T in 8 (5 pro-T, 3 cortical-TIII) and biphenotypic in 1. Molecular studies showed MLL/AF4 rearrangement in 3 and bcr/abl rearrangement in 3 cases, all before tyrosine-kinase inhibitors were available. Karyotypic abnormalities were present in 10 of 16 evaluable cases. Patients were treated in single/double bed rooms with reverse isolation. In 3 cases treatment duration was reduced to 4 days. Results CR was obtained in 13 of 18 patient (72,2%), independently of immunophenotype and time to relapse. CR rate was 100% in all ten patients with karyotypic abnormalities. Three patients (16%) died in aplasia during treatment, 2 of septic shock and 1 of unexplained shock. Two patients (T-ALL) were resistant. Recovery of neutrophils (>0,5×109/L) and platelets (>20×109/L) required a median of 22 days (range 17-37) and 28 days (range 21-45) from the start of therapy, respectively. Infections were documented in 9 of 18 (50%), being fatal in 2 (11%). Non-haematologic toxicity, mainly mucositis, was negligible. The median duration of CR was 5 months (range 2-5) which allowed 9 of 13 CR patients (69%) to undergo allo-HSCT (7 MUD, 1 HLA-identical sibling and 1 cord blood) after a median of 4 months (range 2-7) from CR. Reason for not being transplanted was failure of donor search in 4 patients who relapsed a median of 4 months. Causes of death included progressive disease in 7 patients, in 3 cases after HSCT, and transplant-related toxicity in 3 patients. The median survival of patients achieving CR was 13 months (range 7-33) and overall survival of the entire cohort was 8 months (range 1-33m). Conclusions With MECp, a combination of drugs not used during previous first-line therapy, a higher CR rate (72%) than commonly reported could be obtained, with acceptable toxicity. CR duration was long enough to allow 44,4% of patients to receive a non-family donor allo-HSCT, which is presently the best, yet still unsatisfactory, treatment option for adult patients with refractory/relapsed ALL. Disclosures: No relevant conflicts of interest to declare.

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