Author/Editor		Modic, Mojca
Title		Zdravljenje akutne limfoblastne levkemije odraslih s protokolom UKALL XII
Translated title		Treatment of acute limphoblastic leukemia in adults with UKALL XII protocol
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 5
Publication year		2000
Volume		str. 109-16
Language		slo
Abstract		Background. The prognosis of acute lymphoblastic leukemia (ALL) in adults is far worse than that in children in terms of induction of complete remision (61-85%) and leukemia-free survival 3-5 years (35%). The UKALL XII regiment was studied at the Department of haematology, University Medical Centre Ljubljana. Methods. Between November 1994 and July 2000 34 adults patients with newly diagnosed ALL were eligible for induction chemotherapy (UKALL XII regiment). The median age of the patients was 26 years, range 16-63 years. Induction chemotherapy phase I consisted of daunorubicin, vincristine, prednisolone and L-asparaginase, phase II consisted of cyclophosphamide, cytosine arabinoside, 6-mercaptopurine and intrathecal methotrexat, followed by an intensification module with high dose methotrexate, consolidation, and mainte.nance che- motheraupy (13 months). The expression of cell surface marker at first diagnosis was stu- died. Cytogenetic investigation was performed on bone marrow in 26 patients. Results and eonclusion. 22 (65%) of patients achived complete remission. The median of the remission duration was 29 months (range 2-52 months). Estimated rate of relaps-free survival at 40 months was 31%. The median of the overall survival in all patients was 18 months. Age less than 35 years was a prognostic factor for longer survival. 6 patients (17%) died within 6 weeks after starting the chemotherapy. Predominant causes of mortality proved to be infection and haemorhage. One patient underwent singenic, 3 patients allogeneic stem cell transplantation (SCT) in first remission. 5 patients underwent autologous SCT, 3 in first remission and 2 in second remission. Regiment UKALL XII is quite agressive and complicated. The duration of treatment is 2 years. Karyotype represents a significant prognostic factor in patients with ALL, regardless of other initial clinical characterisdcs.
Summary		Izhodišča. Zdravljenje akutne limfoblastne levkemije (ALL) je pri odraslih manj uspešno kot pri otrocih, zato je potrebna intenzivna kombinacija več citostatikov. Popolno remisijo dosežemo pri odraslih v 61-85 % in tri-petletno trajanje remisije v 35 %. Hoteli smo oceniti zdravljenje novo odkrite ALL pri odraslih po protokolu UKALL XII, ki ga uporabljamo na Kliničnem oddelku za hematologijo v Ljubljani. Material in metode. Od novembra 1994 do julija 2000 smo zdravili 34 odraslih bolnikov z novoodkrito ALL po protokolu UKALL XII. Mediana starosti bolnikov je bila 26 let, razpon od 16 do 63 let. Za indukcijo remisije smo v prvi fazi uporabili citostatike daunoblastin, vinkristin, prednisolon in L-asparaginazo, v drugi fazi pa ciklofosfamid, citozinarabinozid, 6-merkaptopurin in intratekalne injekcije metotreksata. Sledilo je zdravljenje z visokimi odmerki metotreksata, konsolidacija in vzdrževanje remisije (13 mesecev). Pri vseh bolnikih smo blastnim celicam v kostnem mozgu določali celične imunološke označevalce. Pri 26 bolnikih smo naredili tudi citogenetsko preiskavo kostnega mozga. Rezultati in zaključki. Pri 22 bolnikih (65%) smo dosegli remisijo bolezni. Mediana trajanja remisije je bila 29 mesecev, razpon od 2 do 52 mesecev. Verjetnost trajanja obdobja brez bolezni je bilo več kot 40 mesecev pri 31 % bolnikov. Mediana preživetja vseh bolnikov je bila 18 mesecev. Starost bolnikov manj kot 35 let je bil pomemben prognostični dejavnik za trajanje preživetja. 6 bolnikov (17 %) je umrlo v prvih 6 tednih od začetka citostatskega zdravljenja. Najpogostejši vzroki smrti so bile okužbe in krvavitve. Naredili smo eno singenično in 3 alogenične presaditve krvotvornih matičnih celic v prvi remisiji ter 5 avtolognih presaditev, 3 v prvi remisiji in 2 v drugi remisiji ALL. Zdravljenje s protokolom UKALL XII je zelo intenzivno in dokaj zapleteno. Trajanje celotnega zdravljenja je približno dve leti. (Izvleček prekinjen pri 2000znakih).
Descriptors		LEUKEMIA, LYMPHOCYTIC, ACUTE ADULT SURVIVAL ANALYSIS