Treatment of Acute Lymphoblastic Leukaemia in Adolescents and Adults

Abstract

From Jan, 1970, to Dec, 1978, 86 previously untreated adolescents and adults with acute lymphoblastic leukaemia were treated in the University Hospitals at Leiden and Nijmegen. Remissions were induced with vincristine and prednisone. If necessary an anthracyclin derivate was added. 73 Patients (85%) achieved a complete remission. CNS leukaemia prophylaxis was given to 64 patients. Two different schedules were used. 35 patients received cranial irradiation with concomitantly intrathecal injections of methotrexate (I+M) after remission had been achieved, and 29 intrathecal methotrexate (M) alone given peridiocally during the remission induction and maintenance treatment. No CNS leukaemia prophylaxis was given to 9 patients (O). Relapses were confined to the CNS alone in 5 cases (group I+M: 1 case; group M: 1 case; group O: 3 cases), to the bone marrow in 40 cases, and to the bone marrow and CNS concurrently in 5 cases (group I+M: 4 cases; group M: no cases; group O: 1 case). A second remission was obtained in 28 patients (56%). The majority of these patients did not receive further CNS prophylaxis. A second relapse of the leukaemia was seen in the majority (23 patients). CNS involvement was found in 6 of these 23 patients. Prophylactic treatment of the CNS in adult acute lymphoblastic leukaemia is mandatory. In our group of patients both schedules of prophylaxis appeared equally effective in preventing CNS leukaemia.