Adult B-cell acute lymphoblastic leukemias: Conclusions of the Russian prospective multicenter study ALL-2009

E N Parovichnikova; Паровичникова Е Н; V V Troitskaya; Троицкая В В; A N Sokolov; Соколов А Н; S N Bondarenko; Бондаренко С Н; O A Gavrilina; Гаврилина О А; G A Baskhaeva; Басхаева Г А; B V Biderman; Бидерман Б В; I A Lukyanova; Лукьянова И А; L A Kuz'mina; Кузьмина Л А; G A Klyasova; Клясова Г А; S K Kravchenko; Кравченко С К; E O Gribanova; Грибанова Е О; E E Zvonkov; Звонков Е Е; Z Kh Akhmerzaeva; Ахмерзаева З Х; O Yu Baranova; Баранова О Ю; T S Kaporskaya; Капорская Т С; T V Ryltsova; Рыльцова Т В; E N Zotina; Зотина Е Н; E E Zinina; Зинина Е Е; O S Samoilova; Самойлова О С; K D Kaplanov; Капланов К Д; L V Gavrilova; Гаврилова Л В; T S Konstantinova; Константинова Т С; V A Lapin; Лапин В А; A S Pristupa; Приступа А С; A S Eluferyeva; Елуферьева А С; T N Obukhova; Обухова Т Н; I S Piskunova; Пискунова И С; I V Gal'tseva; Гальцева И В; V N Dvirnyk; Двирнык В Н; M A Rusinov; Русинов М А; S M Kulikov; Куликов С М; V G Savchenko; Савченко В Г

doi:10.17116/terarkh201789710-17

Adult B-cell acute lymphoblastic leukemias: Conclusions of the Russian prospective multicenter study ALL-2009

Authors: Parovichnikova EN¹, Troitskaya VV¹, Sokolov AN¹, Bondarenko SN², Gavrilina OA¹, Baskhaeva GA¹, Biderman BV¹, Lukyanova IA¹, Kuz'mina LA¹, Klyasova GA¹, Kravchenko SK¹, Gribanova EO¹, Zvonkov EE¹, Akhmerzaeva ZK.¹, Baranova OY.³, Kaporskaya TS⁴, Ryltsova TV⁵, Zotina EN⁶, Zinina EE⁷, Samoilova OS⁸, Kaplanov KD⁹, Gavrilova LV¹⁰, Konstantinova TS¹¹, Lapin VA¹², Pristupa AS¹³, Eluferyeva AS¹⁴, Obukhova TN¹, Piskunova IS¹, Gal'tseva IV¹, Dvirnyk VN¹, Rusinov MA¹, Kulikov SM¹, Savchenko VG¹
Affiliations:
1. ФГБУ «Гематологический научный центр» Минздрава России
2. ГБОУ ВПО «Первый Санкт-Петербургский государственный медицинский университет им. И.П. Павлова» Минздрава России
3. ФГБНУ «РОНЦ им. Н.Н. Блохина»
4. ГБУЗ «Иркутская ордена «Знак Почёта» областная клиническая больница»
5. ГУЗ ТО «Областная клиническая больница»
6. ФГБУН «Кировский НИИ гематологии и переливания крови» ФМБА
7. БУ «Сургутская окружная клиническая больница»
8. ГБУЗ НО «Нижегородская областная клиническая больница им. Н.А. Семашко»
9. ГБУЗ «Волгоградский областной клинический онкологический диспансер №1»
10. ГБУЗ Республике Мордовия «Мордовская республиканская клиническая больница»
11. Областная клиническая больница №1
12. ГБУЗ Ярославской области «Областная клиническая больница»
13. ГБУ РО «Областная клиническая больница»
14. ГБУЗ «Самарская областная клиническая больница им. В.Д. Середавина»
Issue: Vol 89, No 7 (2017)
Pages: 10-17
Section: Editorial
URL: https://journals.rcsi.science/0040-3660/article/view/32256
DOI: https://doi.org/10.17116/terarkh201789710-17
ID: 32256

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Abstract

Aim. To analyze the efficiency and reproducibility of the ALL-2009 protocol within the Russian prospective multicenter study based on different principles of cytostatic effects (non-intensive, but continuous cytotoxic treatment and a small number of allogeneic hematopoietic stem cells). Subjects and methods. The ALL-2009 (NCT01193933) study conducted in April 2009 to December 2016 included 194 patients (95 males and 99 females) aged 15 to 55 years (median age 28 years) with Ph-negative B-cell acute lymphoblastic leukemia (ALL). There was early pre-B-cell ALL in 54 patients, common ALL in 101, pre-B ALL in 39, initial leukocytosis in 9.4·109/l (0.4-899.0), lactate dehydrogenase in 901 IU (31-13 059), an initial central nervous system lesion in 17 (8.7%), mediastinal injury in 3 (1.5%), and splenomegaly in 111 (57.2%). The results of standard cytogenetic analysis are known in 113 (60.4%) patients. Normal karyotypes were detected in 49 (54.5%) out of the patients; t(4;11) in 9 (5.4%), t(1;19) in 2 (1.2%), and other karyotypic abnormalities in 53 (46.9%). Thirteen (7.8%) patients underwent allogeneic hematopoietic stem cell transplantation in first complete remission (CR); their proportion did not differ in the federal and regional centers. Results. The frequency of CR achievement was the same in the federal and regional centers and generally amounted to 87.5%. Early (8.8%) and CR (9.6%) mortality rates remained high despite the low aggressiveness of cytotoxic action, necessitating the improvement of auxiliary treatment. The five-year overall survival (OS) rates vary considerably in the federal and regional centers (72.6 and 43.8%), the relapse-free survival (RFS) (70.2 and 53.4%) and recurrence risk (23.1 and 36.5%) are comparable. This suggests that the non-intensive, but continuous exposure principle built in the ALL-2009 protocol makes it possible to reproduce the envisaged treatment program and to achieve satisfactory results. Conclusion. The ALL-2009 protocol allows both the federal and regional centers to obtain the long-term results comparable with those of current foreign studies: OS (54.2%), RFS (56.5%); and relapse risk (35.4%). Multivariate analysis has identified age (over 30 years), initial leukocytosis (30·109/l and more) and t(4;11) among the main clinical prognostic factors. Gene mutation detection evaluated in a small number of patients (8/36) is not a poor prognostic sign. There is a need for further investigations with centralized evaluation of the mutation status of leukemic cells and the clearance of minimal residual disease.

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acute Ph-negative B-cell lymphoblastic leukemia, risk factors, cytogenetic abnormalities

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References

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Adult B-cell acute lymphoblastic leukemias: Conclusions of the Russian prospective multicenter study ALL-2009

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