Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: Results from the international ALL trial MRC UKALL XII/ECOG E2993

Hillard M. Lazarus, Susan M. Richards, Raj Chopra, Mark R. Litzow, Alan K. Burnett, Peter H. Wiernik, Ian M. Franklin, Martin S. Tallman, Lucy Cook, Georgina Buck, I. Jill Durrant, Jacob M. Rowe, Anthony H. Goldstone

Research output: Contribution to journalArticle

134 Scopus citations

Abstract

Outcome of acute lymphoblastic leukemia (ALL) in adults with central nervous system (CNS) disease at diagnosis is unclear. We treated 1508 de novo ALL patients with 2-phase induction and then high-dose methotrexate with L-asparaginase. Patients up to 50 years old in first remission (CR1) with a matched related donor (MRD) underwent an allogeneic stem cell transplantation (SCT); the remainder in CR1 were randomized to an autologous SCT or intensive consolidation followed by maintenance chemotherapy. Philadelphia chromosome (Ph)-positive patients were offered a matched unrelated donor (MUD) allogeneic SCT. Seventy-seven of 1508 (5%) patients a median age of 29 years had CNS leukemia at presentation; 13 of the 77 (17%) had Ph-positive ALL. Sixty-nine of 77 (90%) patients attained CR1. Thirty-six patients underwent transplantation in CR1 (25 MRD, 5 MUD, and 6 autografts). Eleven of 25 patients with MRD transplantation remain alive at 21 to 102 months, 2 of 5 with MUD at 42 and 71 months, and 1 of 6 with autologous SCT at 35 months. Seven of 27 treated with consolidation/maintenance remain in CR1 56 to 137 months after diagnosis. Overall survival at 5 years was 29% in those with CNS involvement at diagnosis versus 38% (P = .03) for those without. CNS leukemia in adult ALL is uncommon at diagnosis. Adult Ph-negative ALL patients, however, can attain long-term disease-free survival using SCT as well as conventional chemotherapy.

Original languageEnglish (US)
Pages (from-to)465-472
Number of pages8
JournalBlood
Volume108
Issue number2
DOIs
StatePublished - Jul 15 2006

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Lazarus, H. M., Richards, S. M., Chopra, R., Litzow, M. R., Burnett, A. K., Wiernik, P. H., Franklin, I. M., Tallman, M. S., Cook, L., Buck, G., Jill Durrant, I., Rowe, J. M., & Goldstone, A. H. (2006). Central nervous system involvement in adult acute lymphoblastic leukemia at diagnosis: Results from the international ALL trial MRC UKALL XII/ECOG E2993. Blood, 108(2), 465-472. https://doi.org/10.1182/blood-2005-11-4666