학술논문
Phase II study of dose-adjusted EPOCH as initial therapy for adults with high-risk acute lymphoblastic leukemia.
Document Type
Article
Author
Cassaday, Ryan D.; Zarling, Lucas C.; Garcia, Kelsey-Leigh A.; Sala-Torra, Olga; Stevenson, Philip A.; Martino, Christen H.; Liu, Yajuan J.; Fang, Min; Percival, Mary-Elizabeth M.; Halpern, Anna B.; Becker, Pamela S.; Oehler, Vivian G.; Shustov, Andrei R.; Cooper, Jason P.; Orozco, Johnnie J.; Hendrie, Paul C.; Walter, Roland B.; Radich, Jerald P.; Soma, Lorinda A.; Estey, Elihu H.
Source
Subject
*LYMPHOBLASTIC leukemia
*ACUTE leukemia
*CANCER remission
*SURVIVAL rate
*ADULTS
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Language
ISSN
1042-8194
Abstract
Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense. To address this, we performed a phase II study of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). Imatinib or dasatinib was added for Ph + disease; rituximab was added when CD20+. Fifty-three patients were evaluable: 28 with Ph + disease, and 25 with Ph−. All patients had ≥1 high-risk clinical feature. Measurable residual disease-negativity by multiparameter flow cytometry within 4 cycles was achieved in 71% in patients with Ph + ALL and 64% in Ph − ALL. Median overall survival (OS) was 49 months, with a 2-year OS of 71%. Median relapse-free survival (RFS) in the 47 patients that attained morphologic remission was 24 months, with a 2-year RFS of 57%. Early mortality was 2%. In summary, DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death. [ABSTRACT FROM AUTHOR]