Adult acute lymphoblastic leukaemia: Study of 32 patients and analysis of prognostic factors

The clinical and haematological characters and the response to therapy of 32 consecutive patients with acute lymphoblastic leukemia, aged more than 12 years, were reviewed. All patients were given vincristine (V) and (6-methyl) prednisolone (P) for 6 weeks; daunomycin (D) was added in 9 cases, and cyclophosphamide (C) + (D) in another 10 cases. 3 patients died during induction. 4 patients failed to achieve remission. 25 patients (78%) achieved complete remission (CR). All of them but one received 'prophylactic' central nervous system (CNS) therapy with cranial irradiation and i.t. methotrexate (MTX) and arabinosyl cytosine. CR was maintained with daily 6-mercaptopurine and weekly MTX. Median duration of CR was of 22 months. 2 patients are currently disease-free and off-therapy, 78 and 53 months after diagnosis, respectively. Blast cell membrane markers were studied in 21 consecutive cases: 3 patients had T-cell leukaemia and 2 patients B-cell leukaemia. Prognostic factors were evaluated basing on the present series of 32 patients, and on further 106 cases reported by others. Age (under and above 40) influenced significantly both the CR rate and the length of survival. In patients aged under 40, a circulating blast cell count higher than 25,000/μl, or a platelet count lower than 50,000 μl, negatively affected the survival.