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High-Dose Cytarabine-Mitoxantrone Versus Hyper-CVAD in Adult Acute Lymphoblastic Leukemia and Burkitt’s Lymphoma: A Single Center Experience of Two Induction Regimens

The treatment of acute lymphoblastic leukemia (ALL) in children has made significant progress. However, the treatment for adult ALL patients has been less successful. The majority of adult patients develop recurrent disease and subsequently die of their leukemia. This study reports a single center experience of adult ALL therapy with two different induction regimens. 73 adult patients with newly diagnosed ALL were treated at the Westchester Medical Center. These patients received induction chemotherapy with either high dose mitoxantrone and high-dose cytarabine (HDAM, n=52) or Hyper-CVAD (n=21). The complete remission (CR) rate was 87% in the HDAM group and 76% in the Hyper-CVAD group (p=0.31). The median CR duration was 34 months (95% CI, 14 -) for the HDAM group, and 18 months (95% CI, 9 -) for the hyper-CVAD group, respectively. The median overall survival (OS) for patients in the HDAM group was 21 months (95% confidence interval [CI], 13 35 months). The 3-year and 5-year OS was 35% and 30%, respectively. In the Hyper-CVAD group, median OS was 27 months (95% CI, 12 -), with a 3-year OS of 44%. The difference of CR duration and OS between the two groups was not statistically significant (p= 0.86 for CR, p=0.73 for OS). The statistically significant favorable prognostic factors for overall survival include HDAM induction, karyotyping other than t(9;22) and t(4;11), day 1 platelet count 20,000 x 10 6 /L, age < 35, day 1 WBC <10 x 10 6 /L. In conclusion, the two regimens are comparable in this retrospective analysis for ALL induction from a single center. HDAM induction was found to be a favorable prognostic factor for overall survival.