Results of induction therapy with vincristine and prednisone alone in adult acute lymphoblastic leukemia: report of 43 patients and review of the literature.

Abstract

AbstractThe complete remission (CR) rate in children with acute lymphoblastic leukemia (ALL) who received vincristine (VCR) plus prednisone (PRED) alone for induction is > 90%, and has not improved with the use of more intensive regimens. In adults with ALL, using the same regimen, a CR rate of only 50% is frequently quoted, and is apparently based mainly on unpublished data on only 13 patients from an early Acute Leukemia Group B protocol. We reviewed the case records of 43 adults with previously untreated ALL seen between July 1, 1966 and December 31, 1978 who received VCR + PRED alone for induction. A CR rate of 66% was achieved and compares to an overall figure of 61% from 162 patients collected from the literature. The CR rate was age dependent with 21/29 (76%) < 50 years of age achieving a CR compared to 4/19 (29%) who were < 50 years of age (P < 0.02). The median duration of CR was 8.3 months. For those who achieved a CR, the median survival was 19 months compared to five months for those who either failed to achieve a CR or who achieved only a partial remission (P = 0.004). All patients who achieved a CR received maintenance therapy, and approximately one‐half also received CNS prophylaxis with intrathecal methotrexate. The incidence of isolated CNS relapse was 11% in those who received CNS prophylaxis compared to 20% in those who did not.From these data and a review of the literature, we conclude that approximately two‐thirds of adults with ALL will achieve a CR with the use of VCR + PRED alone. The median duration of CR, however, is < one year and the median survival is approximately two years. Whether the use of more intensive induction, consolidation, and maintenance regimens will improve these results remains to be established.