Combination chemotherapy for acute lymphocytic leukemia in adults: Results of a retrospective study in 82 patients

Abstract Since 1970, 82 previously untreated adult patients with acute lymphocytic leukemia (ALL) were treated for induction of remission with combination chemotherapy either including vincristine and prednisone (18 patients), vincristine, prednisone and daunomycin (27 patients), or vincristine, prednisone, and asparaginase (37 patients). Upon achievement of complete remission patients were started on continuous maintenance with daily mercaptopurine, weekly methotrexate, and periodic vincristine and prednisone reinforcement pulses. Central nervous system prophylaxis consisted of six weekly intrathecal injections of methotrexate and prednisone given during induction, followed by monthly doses during maintenance. Overall, 55 of the 82 patients (67%) achieved complete remission; the addition of daunomycin or asparaginase to vincristine and prednisone did not significantly improve the response rate. Severe myelosuppression was common, being responsible for the death of 23 patients during induction. The predicted median duration of remission was 25 months, with 24 patients continuing in remission after 3.5–60 months. Duration of remission was significantly shorter in those patients who initially had a peripheral blood count greater than 50 × 10 9 /liter. The predicted median survival was 39.5 months in those who achieved remission, less than one month in those who did not, and 12 months overall.