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BACKGROUND: Results from salvage therapy in adult patients with acute lymphocytic leukemia (ALL) are wide-ranging and depend on several disease and patient characteristics. The objectives of this study were to define the prognosis for adult patients with ALL after first salvage through multivariate analyses of patient and disease characteristics. METHODS: Adults with ALL who had primary resistance to frontline therapy or who had a disease recurrence after a first complete response (CR) duration 55 years, bone marrow blasts ≥20%, and platelet count 55 years, bone marrow blasts ≥20%, platelet count <75 × 10(9) /L, albumin level <3 g/L, and lactic dehydrogenase level ≥1000 IU/L. Patients who had ≥3 of the 5 adverse factors (45%) had a median survival of 2 to 3 months and CR rates of 8% to 15%. Achieving CR was associated independently with improved survival in a landmark multivariate analysis (P < .0001; hazard ratio, 0.40; 95% confidence interval, 0.03-0.72). CONCLUSIONS: The current analyses identified a subset of adults patients ALL in first salvage for whom standard therapies were associated with an extremely poor outcome. The results also confirmed the importance of achieving CR to attain improved survival.
Kantarjian et al. (Tue,) studied this question.