TY - JOUR
T1 - Long-term follow-up of treatment and potential cure of adult acute lymphocytic leukemia with MOAD
T2 - A non-anthracycline containing regimen
AU - Wiernik, Peter H.
AU - Dutcher, Janice P.
AU - Paietta, Elisabeth
AU - Gucalp, Rasim
AU - Markus, Susan
AU - Weinberg, Vivian
AU - Azar, Catherine
AU - Garl, Susan
AU - Benson, Laura
PY - 1993/8
Y1 - 1993/8
N2 - A total of 55 previously untreated adults with acute lymphocytic leukemia (ALL), median age 38 years (range 15-73 years), were treated with MOAD (methotrexate, vincristine, L-asparaginase, and dexamethasone). This regimen includes five phases - induction, consolidation, cytoreduction, maintenance, and central nervous system (CNS) prophylaxis with patenteral high-dose methotrexate. Of the 55 evaluable patients, 42 achieved complete remission (76 % ), with a median CR duration of 12 + months (range 0.5-195 + months). The median survival in remission is 22 + months (range 1-198 + months), with 33% of remitters continuing in long-term remissions (> 5 years). Two out of four patients who developed CNS leukemia did so without marrow relapse, were sucessfully treated for that complication, and continue in total complete remission at 8+ and 16+ years. Another patient with extramedullary relapse (breast) was treated with radiation to that site and remains in total CR at 16+ years. Expected toxicities included myelosuppression during the induction phase of treatment, with 65% of patients requiring intravenous antibiotics. Mucositis was the next most frequent toxicity and required dose-reduction in seven patients. Minimal toxicity was seen during the postremission phases of treatment. L-Asparaginase toxicity was more prominent during intravenous administration (24 patients) than when the intramuscular route of administration (30 patients) was used. The remission rate and long-term survivorship achieved with this regimen, without the use of an anthracycline, is comparable to that of other regimens for adult ALL. MOAD was well-tolerated by young and old adults with ALL. Aseptic necrosis of bone, successfully treated in each instance, occurred in four long-term disease-free survivors. The effect of this complication and its treatment on quality of life has been negligible.
AB - A total of 55 previously untreated adults with acute lymphocytic leukemia (ALL), median age 38 years (range 15-73 years), were treated with MOAD (methotrexate, vincristine, L-asparaginase, and dexamethasone). This regimen includes five phases - induction, consolidation, cytoreduction, maintenance, and central nervous system (CNS) prophylaxis with patenteral high-dose methotrexate. Of the 55 evaluable patients, 42 achieved complete remission (76 % ), with a median CR duration of 12 + months (range 0.5-195 + months). The median survival in remission is 22 + months (range 1-198 + months), with 33% of remitters continuing in long-term remissions (> 5 years). Two out of four patients who developed CNS leukemia did so without marrow relapse, were sucessfully treated for that complication, and continue in total complete remission at 8+ and 16+ years. Another patient with extramedullary relapse (breast) was treated with radiation to that site and remains in total CR at 16+ years. Expected toxicities included myelosuppression during the induction phase of treatment, with 65% of patients requiring intravenous antibiotics. Mucositis was the next most frequent toxicity and required dose-reduction in seven patients. Minimal toxicity was seen during the postremission phases of treatment. L-Asparaginase toxicity was more prominent during intravenous administration (24 patients) than when the intramuscular route of administration (30 patients) was used. The remission rate and long-term survivorship achieved with this regimen, without the use of an anthracycline, is comparable to that of other regimens for adult ALL. MOAD was well-tolerated by young and old adults with ALL. Aseptic necrosis of bone, successfully treated in each instance, occurred in four long-term disease-free survivors. The effect of this complication and its treatment on quality of life has been negligible.
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M3 - Article
C2 - 8350624
AN - SCOPUS:0027209928
SN - 0887-6924
VL - 7
SP - 1236
EP - 1241
JO - Leukemia
JF - Leukemia
IS - 8
ER -