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High-dose cytarabine in upfront therapy for adult patients with acute lymphoblastic leukaemia
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
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2002 In: British Journal of Haematology, ISSN 0007-1048, Vol. 118, no 3, 748-754 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2002. Vol. 118, no 3, 748-754 p.
Identifiers
URN: urn:nbn:se:uu:diva-92959OAI: oai:DiVA.org:uu-92959DiVA: diva2:166292
Available from: 2005-04-27 Created: 2005-04-27Bibliographically approved
In thesis
1. Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
Open this publication in new window or tab >>Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment results and clinical characteristics in adult acute lymphoblastic leukaemia (ALL) were evaluated regarding three issues: a new treatment with cytarabine up-front, stem cell transplantation and a comparison between adult and paediatric treatment protocols. All studies were conducted on a national basis. Furthermore, activity of imatinib was investigated by in vitro cytotoxicity assay.

The national protocol was evaluated in 153 adult ALL patients. A high complete remission rate, 86%, was achieved with 29% overall survival at 3-years. Favourable outcome was identified in patients < 40 years with precursor B phenotype and continuous complete remission was higher for precursor B compared to T-ALL.

Stem cell transplantation was evaluated in 187 patients. No differences in outcome between allogeneic and autologous transplantation were found, with the exception of Philadelphia-positive ALL, in which allogeneic transplantation was preferable. Limited chronic graft-versus-host disease (compared to none) resulted in superior disease free survival.

The paediatric NOPHO-92 and the Adult protocols were evaluated for 243 ALL-patients. Superior remission rate and survival were achieved for 10-18 year-olds treated according to the Paediatric protocol compared to both 15-25 and 25-40 year-olds treated according to the Adult protocol. Treatment protocol was a significant prognostic factor for patients aged 15-20 years.

Fluorometric Microculture Cytotoxicity Assey was used to analyze 15 tumour cell samples from ALL patients. High concordance was determined between in vitro sensitivity to imatinib and presence of BCR-ABL. Daunorubicin, prednisolone and cytarabine had the greatest benefit from a combination with imatinib.

The national adult treatment protocol’s results were consistent with international trials regarding precursor B ALL but may be under performing for T-ALL. Adolescents may benefit from treatment according to the Paediatric protocol. No difference in outcome between allogeneic and autologous stem cell transplantation was determined except for Philadelphia-positive patients, despite the indication of a graft-versus-leukaemia effect.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 54 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 30
Keyword
Medicine, acute lymphoblastic leukaemia, adult, adolescent, chemotherapy, stem cell transplantation, in vitro assay, imatinib, Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:uu:diva-5768 (URN)91-554-6229-4 (ISBN)
Public defence
2005-05-19, Enghoffsalen, Akademiska sjukhuset, Ingång 50, Uppsala, 09:15
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Supervisors
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2011-06-10Bibliographically approved

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