Citations 3
At three years, patients with acute lymphoblastic leukaemia are still at risk for relapse. Results of the international MRC UKALLXII/ECOG E2993 trial
Ganzel, Chezi , Wang, Xin V., Rowe, Jacob M. , Richards, Susan , Buck, Georgina , Marks, David I. , Litzow, Mark R. , Paietta, Elisabeth , Foroni, Letizia, Luger, Selina M. , Wiernik, Peter H. , Douer, Dan , Tallman, Martin S. , Goldstone, Anthony H., Richards, Susan M., Willman, Cheryl L. , Mullighan, Charles G. , Roberts, Kathryn G. , Lazarus, Hillard M.
British Journal of Haematology | March 27, 2020 | Volume: 191 | Issue: 1 | Pages: 37-43
Summary Late relapse [>3 years from complete remission (CR)] in acute lymphoblastic leukaemia (ALL), is unusual. Data from the MRC UKALLXII/ECOG E2993 trial are presented to evaluate the incidence and characteristics of late relapse in adult ALL. Of 1,909 patients, 1,752 (92%) achieved CR and among these 757 (43·2%) relapsed; 691 (91·3%) within three years and 66 (8·7%) beyond. Among these 66 patients, median time to relapse was 47 (37–144) months. Relapse beyond three years occurred in 3·8% of all who achieved CR. The cumulative risk of relapse was 40%, 43% and 45% at three, five and ten years respectively. Out of the 1 752 patients who achieved CR, 11·7% underwent autologous and 40·6% allogeneic transplant, while in CR1. Of the autologous patients, 43·2% relapsed early and 3·4% relapsed late. However, among the allogeneic patients, 13·2% relapsed early and only 1·3% late. The five‐year overall survival from relapse was 5·8% and 20% in the early and late relapse patients respectively. In conclusion, late relapse in adults with ALL is not uncommon, and is associated with better outcome after relapse compared to early relapse.
Ibrutinib–Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia
Shanafelt, Tait D. , Wang, Xin V., Hanson, Curtis A. , Jelinek, Diane F., Braggio, Esteban , Leis, José F., Zhang, Cong C., Coutré, Steven , Cashen, Amanda F. , Mato, Anthony R. , Singh, Avina K., Mullane, Michael P., Little, Richard F. , Stone, Richard M. , Litzow, Mark R. , Tallman, Martin S. , O'Brien, Susan, Barrientos, Jacqueline, Coutre, Steven E, Barr, Paul M , Tallman, Martin, Shanafelt, Tait D , Braggio, Esteban , Kay, Neil E. , O’Brien, Susan , Barrientos, Jacqueline C. , Barr, Paul M. , Erba, Harry Paul
New England Journal of Medicine | July 31, 2019 | Volume: 381 | Issue: 5 | Pages: 432-443
A randomized trial of three novel regimens for recurrent acute myeloid leukemia demonstrates the continuing challenge of treating this difficult disease
Litzow, Mark R. , Wang, Xin V., Karp, Judith E. , Zhang, Yanming , Luger, Selina M. , Paietta, Elisabeth , Pratz, Keith W. , Altman, Jessica K. , Broun, E. Randolph, Rybka, Witold B. , Rowe, Jacob M. , Tallman, Martin S. , Kaufmann, Scott H. , Pratz, Keith W , Tun, Han Win, Carroll, Martin P , Ketterling, Rhett P. , Lazarus, Hillard M. , Tun, Han W.
American Journal of Hematology | October 29, 2018 | Volume: 94 | Issue: 1 | Pages: 111-117
To improve the outcome of relapsed/refractory acute myeloid leukemia (AML), a randomized phase II trial of three novel regimens was conducted. Ninety patients were enrolled and were in first relapse or were refractory to induction/re‐induction chemotherapy. They were randomized to the following regimens: carboplatin‐topotecan (CT), each by continuous infusion for 5 days; alvocidib (formerly flavopiridol), cytarabine, and mitoxantrone (FLAM) in a timed sequential regimen; or sirolimus combined with mitoxantrone, etoposide, and cytarabine (S‐MEC). The primary objective was attainment of a complete remission (CR). A Simon two‐stage design was used for each of the three arms. The median age of the patients in the FLAM arm was older at 62 years compared with 55 years for the CT arm and the S‐MEC arm. The overall response was 14% in the CT arm (5/35, 90% CI 7%‐35%), 28% in the FLAM arm (10/36, 90% CI, 16%‐43%), and 16% in the S‐MEC arm (3/19, 90% CI, 4%‐36%). There were nine treatment‐related deaths, seven of which occurred in the FLAM arm with four of these in elderly patients. We conclude that the FLAM regimen had an encouraging response rate and should be considered for further clinical development but should be used with caution in elderly patients.