Long-term follow-up of treatment and potential cure of adult acute lymphocytic leukemia with MOAD: A non-anthracycline containing regimen

Peter H. Wiernik, Janice P. Dutcher, Elisabeth M. Paietta, Rasim A. Gucalp, Susan Markus, Vivian Weinberg, Catherine Azar, Susan Garl, Laura Benson

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1236-1241
Number of pages6
JournalLeukemia
Volume7
Issue number8
StatePublished - Aug 1993

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Asparaginase
Methotrexate
Therapeutics
Central Nervous System
Recurrence
Mucositis
Osteonecrosis
Anthracyclines
Vincristine
Intravenous Administration
Dexamethasone
Survivors
Young Adult
Leukemia
Breast
Survival Rate
Bone Marrow
Maintenance
Quality of Life

ASJC Scopus subject areas

  • Cancer Research
  • Hematology

Cite this

Long-term follow-up of treatment and potential cure of adult acute lymphocytic leukemia with MOAD : A non-anthracycline containing regimen. / Wiernik, Peter H.; Dutcher, Janice P.; Paietta, Elisabeth M.; Gucalp, Rasim A.; Markus, Susan; Weinberg, Vivian; Azar, Catherine; Garl, Susan; Benson, Laura.

In: Leukemia, Vol. 7, No. 8, 08.1993, p. 1236-1241.

Research output: Contribution to journalArticle

Wiernik, PH, Dutcher, JP, Paietta, EM, Gucalp, RA, Markus, S, Weinberg, V, Azar, C, Garl, S & Benson, L 1993, 'Long-term follow-up of treatment and potential cure of adult acute lymphocytic leukemia with MOAD: A non-anthracycline containing regimen', Leukemia, vol. 7, no. 8, pp. 1236-1241.
Wiernik, Peter H. ; Dutcher, Janice P. ; Paietta, Elisabeth M. ; Gucalp, Rasim A. ; Markus, Susan ; Weinberg, Vivian ; Azar, Catherine ; Garl, Susan ; Benson, Laura. / Long-term follow-up of treatment and potential cure of adult acute lymphocytic leukemia with MOAD : A non-anthracycline containing regimen. In: Leukemia. 1993 ; Vol. 7, No. 8. pp. 1236-1241.
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abstract = "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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AU - Paietta, Elisabeth M.

AU - Gucalp, Rasim A.

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