Department of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Acta Haematol. 2013;130(3):199-205. doi: 10.1159/000351172. Epub 2013 Jun 19.
Treatment of acute lymphoblastic leukemia is unsatisfactory in adults due to disease and patient-related factors and probably because adult chemotherapy regimens are weaker than pediatric protocols. Worries about inadequacy of adult regimens urged many hematologists, including us, to reconsider their routine treatment practices. In this retrospective multicenter study, we aimed to evaluate results of hyper-CVAD treatment in comparison to other intensive protocols. All patients aged ≤65 years who were commenced on intensive induction chemotherapy between 1999 and 2011 were included in the study. Sixty-eight of 166 patients received hyper-CVAD, 65 were treated with CALGB-8811 regimen and 33 with multiple other protocols. Limited number of patients who were treated with other intensive protocols and mature B-acute lymphoblastic leukemia cases who were mostly given hyper-CVAD were eliminated from the statistical analyses. In spite of a favorable complete remission rate (84.2%), overall (26.3 vs. 44.2% at 5 years, p = 0.05) and disease-free (24.9 vs. 48.2%, p = 0.001) survival rates were inferior with hyper-CVAD compared to CALGB-8811 due to higher cumulative nonrelapse mortality risk (29.7 vs. 5.9%, p = 0.003) and no superiority in cumulative relapse incidence comparison (45% for both arms, p = 0.44). Hyper-CVAD, in its original form, was a less favorable regimen in our practice.
成人急性淋巴细胞白血病的治疗效果不理想，这与疾病和患者相关因素有关，可能还与成人化疗方案不如儿科方案强有关。对成人方案不足的担忧促使包括我们在内的许多血液学家重新考虑其常规治疗实践。在这项回顾性多中心研究中，我们旨在评估高剂量 CVAD 治疗与其他强化方案相比的结果。本研究纳入了 1999 年至 2011 年间接受强化诱导化疗的所有年龄≤65 岁的患者。166 例患者中有 68 例接受了高剂量 CVAD，65 例接受了 CALGB-8811 方案治疗，33 例接受了其他多种方案治疗。由于接受其他强化方案治疗的患者数量有限，以及接受高剂量 CVAD 治疗的成熟 B 急性淋巴细胞白血病患者数量有限，因此这些患者被排除在统计分析之外。尽管完全缓解率（84.2%）良好，但高剂量 CVAD 组的总生存率（26.3%比 5 年时的 44.2%，p=0.05）和无病生存率（24.9%比 48.2%，p=0.001）均低于 CALGB-8811 组，这是由于高剂量 CVAD 组累积非复发死亡率较高（29.7%比 5.9%，p=0.003），且累积复发率无优势（两组均为 45%，p=0.44）。高剂量 CVAD 按原方案在我们的实践中效果较差。
