Treatment of Adult Acute Lymphoblastic Leukemia (ALL) with a Modified DFCI Pediatric Regimen - The Princess Margaret Experience.
Notice bibliographique
Résumé
Abstract Between June 2000 and December 2004, 68 adult patients with newly diagnosed ALL were treated at Princess Margaret Hospital in Toronto, Canada using a modified Dana Farber Cancer Institute pediatric ALL protocol (DFCI 91-01). This protocol includes a remission induction phase, a CNS prophylaxis phase with intrathecal chemotherapy and 12 Gy cranial irradiation, a 30-week intensification phase, and a 72-week maintenance phase. Since 2002, bcr-abl+ patients received concurrent therapy with imatinib mesylate. Before 2002, all patients in CR1 were referred for allogeneic stem cell transplant (alloSCT) if a suitable matched sibling donor was identified (n=11); after 2002, only high-risk patients were referred for alloSCT (n=14). In addition bcr-abl+ and t(4:11) patients were considered for matched unrelated donor alloSCT. Median age was 34.5 years (range, 17–61 years). Sixteen (23.5%) patients were bcr-abl+ and 13 (19.1%) pre-B with WBC > 30. Ten of 16 (62.5%) of the bcr-abl+ patients received concurrent imatinib mesylate; 11 of 16 (69%) of these subsequently underwent alloSCT. The complete remission (CR) rate was 85.4% (58/68), with a 5.9% induction death rate. CNS prophylaxis was administered to 54 patients and was well tolerated. Fifty-seven patients proceeded to therapy in the intensification phase, which consisted of vincristine (VCR) 2 mg × 10 doses, L-asparaginase (l-asp) 12,500 IU/m2 weekly × 30 doses, doxorubicin 30 mg/m2 × 7 doses, 6-mercaptopurine, dexamethasone and methotrexate. Thirty-four patients completed this phase, while 18 patients had an abbreviated course of intensification before proceeding to alloSCT. Major side effects during the intensification phase included grade 3–4 neutropenia (63%), peripheral neuropathy (40%), thrombosis (17.5%) and central venous catheter infection (18.2%). Intensification was administered on an outpatient basis with 12/57 (21%) requiring hospitalization for any reason. Maintenance therapy was given to 32 patients and was well tolerated. At a median follow-up of 2.7 years (range, 0.05–5.8 years), both median overall survival (OS) and relapse free survival (RFS) were 4.9 years. Among non-transplanted patients (n=44), Kaplan-Meier 3-year OS and RFS were 65.5% and 77.3%, respectively with most deaths occurring in induction or from progressive leukemia in primary non-responders. For the entire group, younger age (< 25 years) was associated with improved OS and RFS (p= 0.03) whereas bcr-abl positivity was not. Due to neuropathy, vinblastine (VBL) was substituted for VCR in 13/33 (39.4%) patients during intensification without affecting RFS and OS (p=0.22). Of the 34 patients who completed intensification without relapse, those who received >80% of the targeted l-asp dose had a significantly longer OS (p=0.02) and RFS (p=0.04). These results demonstrate the feasibility of administering the pediatric DFCI protocol to adults up to the age of 61 years with acceptable toxicity. As with the DFCI pediatric experience (Blood2001; 97(5): 1211-8), the ability to deliver >80% of the targeted l-asparaginase dose during the intensification phase appears to produce improved efficacy. Longer follow-up will be needed to further characterize the anti-leukemic efficacy of this regimen in adults.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».