Contributions
Type: Publication Only
Background
The ASR incidence of acute lymphoblastic leukemia (ALL) in U.S. is 1.6 cases per 100,000, with 6,050 de novo cases per year and 1,440 deaths estimated during 2012.
ALL accounts for 80% of all acute leukemias in children, with 3-years overall-survival (OS) around 80%. In adults, ALL is responsible of 20% of acute leukemias, with 3-year OS around 40%.
In Colombia, the statistics are poor. Globocan and National Cancer Institute of Colombia estimated approximately 2,500 cases of leukemias in 2012, with an ASR incidence of 6.3 per 100,000 and an ASR mortality of 4.8 per 100,000. Taking into account these dates, approximately 73% of patients diagnosed with any kind of leukemia in Colombia die.
Treatment response rates and OS data in Colombia are even scarcer; the study of the National Cancer Institute found a complete response (CR) rate of 64% and 3 years OS of 0%.
Aims
To determine the CR rate to treatment, disease-free survival (DFS) and (OS) in adults with ALL treated with different chemotherapy protocols in Hospital Militar Central (HMC) (Bogotá, Colombia) between 2006-2012.
Methods
A retrospective study was made on newly diagnosed ALL patients who came to HMC from January 2006 to December 2012. Descriptive statistics and cross-tabulation were used to describe patient characteristics. Mann-Whitney analyses were used to determine between-group differences. OS and DFS were analyzed with Kaplan- Meier method
Results
Thirty-four patients older than 15 years were diagnosed with de novo ALL. Mean age was 28.5 years-old; 55.9% of cases had between 15 to 24 years-old. 23.5% of patients were older than 35 years- old, of which 25% had t(9;22). Mean leukocyte count was 38,490/uL (1500-367.000/uL). Anemia was present in 86.7% and 20.6% of patients had normal platelet count.
Twenty-six patients (76.5%) showed B-cell lineage, while T-cell lineage was found in 5 cases (14.7%). Ten patients (38.5%) with B-cell lineage had leukocyte count ≥ 30,000/µL (avg. 82,318/µL). All patients with T-cell lineage had leukocyte count less than 100,000/µL (avg. 17,536/µL).
Karyotype was normal in 22 cases (64.7%). 80% of patients with abnormal karyotype had t(9;22), of which 66.7% had hyperleucocytosis.
Twenty patients (58.8%) were at high risk for systemic relapse, (presence of one or more of the following: hyperleucocytosis ≥ 30,000/ul in B-cell phenotype, hyperleucocytosis ≥100.000/uL in T-cell phenotype, age ≥ 35 years, CD20 positivity >20% and t(9;22). The other molecular risk factors are not available in Colombia.
The most frequent chemotherapy protocol used was GMALL (35%) followed by FRALLE 93 (29%). Two patients (5.9%) died during induction phase. Twenty-eight cases (82.3%) entered CR after induction therapy. Minimal residual disease was evaluated by flow cytometry in 17 patients (60.7%), being positive in 10 (58.8%) and negative in 7 (41.2%).
From 28 patients who entered CR after induction therapy, 9 cases relapsed; 88.9% of relapses occurred during first 12 months. Mean time to relapse was 7.4 months. All patients who relapsed received second-line protocol (R HyperCvad, HyperCvad, BFM Retz, IDA-FLAG and ALL R3) and only 3 responded (42.8%).
OS and DFS at the first year was 92% and 84.8%, respectively. The OS and DFS to 3 years was 29.5% and 32.4%, respectively.
Summary
Comparing data previously obtained by National Cancer Institute between 2001-2005, this study shows improved CR rates and OS in ALL in Colombia during recent years. However these data are still less favorable than those obtained in studies from developed countries.
Keyword(s): ALL, Chemotherapy, Survival
Type: Publication Only
Background
The ASR incidence of acute lymphoblastic leukemia (ALL) in U.S. is 1.6 cases per 100,000, with 6,050 de novo cases per year and 1,440 deaths estimated during 2012.
ALL accounts for 80% of all acute leukemias in children, with 3-years overall-survival (OS) around 80%. In adults, ALL is responsible of 20% of acute leukemias, with 3-year OS around 40%.
In Colombia, the statistics are poor. Globocan and National Cancer Institute of Colombia estimated approximately 2,500 cases of leukemias in 2012, with an ASR incidence of 6.3 per 100,000 and an ASR mortality of 4.8 per 100,000. Taking into account these dates, approximately 73% of patients diagnosed with any kind of leukemia in Colombia die.
Treatment response rates and OS data in Colombia are even scarcer; the study of the National Cancer Institute found a complete response (CR) rate of 64% and 3 years OS of 0%.
Aims
To determine the CR rate to treatment, disease-free survival (DFS) and (OS) in adults with ALL treated with different chemotherapy protocols in Hospital Militar Central (HMC) (Bogotá, Colombia) between 2006-2012.
Methods
A retrospective study was made on newly diagnosed ALL patients who came to HMC from January 2006 to December 2012. Descriptive statistics and cross-tabulation were used to describe patient characteristics. Mann-Whitney analyses were used to determine between-group differences. OS and DFS were analyzed with Kaplan- Meier method
Results
Thirty-four patients older than 15 years were diagnosed with de novo ALL. Mean age was 28.5 years-old; 55.9% of cases had between 15 to 24 years-old. 23.5% of patients were older than 35 years- old, of which 25% had t(9;22). Mean leukocyte count was 38,490/uL (1500-367.000/uL). Anemia was present in 86.7% and 20.6% of patients had normal platelet count.
Twenty-six patients (76.5%) showed B-cell lineage, while T-cell lineage was found in 5 cases (14.7%). Ten patients (38.5%) with B-cell lineage had leukocyte count ≥ 30,000/µL (avg. 82,318/µL). All patients with T-cell lineage had leukocyte count less than 100,000/µL (avg. 17,536/µL).
Karyotype was normal in 22 cases (64.7%). 80% of patients with abnormal karyotype had t(9;22), of which 66.7% had hyperleucocytosis.
Twenty patients (58.8%) were at high risk for systemic relapse, (presence of one or more of the following: hyperleucocytosis ≥ 30,000/ul in B-cell phenotype, hyperleucocytosis ≥100.000/uL in T-cell phenotype, age ≥ 35 years, CD20 positivity >20% and t(9;22). The other molecular risk factors are not available in Colombia.
The most frequent chemotherapy protocol used was GMALL (35%) followed by FRALLE 93 (29%). Two patients (5.9%) died during induction phase. Twenty-eight cases (82.3%) entered CR after induction therapy. Minimal residual disease was evaluated by flow cytometry in 17 patients (60.7%), being positive in 10 (58.8%) and negative in 7 (41.2%).
From 28 patients who entered CR after induction therapy, 9 cases relapsed; 88.9% of relapses occurred during first 12 months. Mean time to relapse was 7.4 months. All patients who relapsed received second-line protocol (R HyperCvad, HyperCvad, BFM Retz, IDA-FLAG and ALL R3) and only 3 responded (42.8%).
OS and DFS at the first year was 92% and 84.8%, respectively. The OS and DFS to 3 years was 29.5% and 32.4%, respectively.
Summary
Comparing data previously obtained by National Cancer Institute between 2001-2005, this study shows improved CR rates and OS in ALL in Colombia during recent years. However these data are still less favorable than those obtained in studies from developed countries.
Keyword(s): ALL, Chemotherapy, Survival