Alvarado-Ibarra M, Tapia-Enríquez AL, López-Hernández M, Álvarez-Vera JL, Ortiz-Zepeda M, Ramos-León E

Language: Spanish
References: 25
Page: 271-280
PDF size: 457.58 Kb.

ABSTRACT

Background: The course and prognosis of patients with acute lymphoblastic leukemia (ALL) in adults persist still bad despite the new treatment with which account, a significant percentage of patients experience relapse and rescue schemes offer low frequencies of complete remission (CR) with major toxicity and treatment related mortality (TRM); with overall survival and disease free survival shortened.
Objective: To compare the efficacy and safety of chemotherapy rescue schemes administered to patients with relapsed acute lymphoblastic leukemia treated at the Hematology Service of CMN 20 de Noviembre, in Mexico City.
Patients and method: A retrospective, longitudinal and comparative cohort, from January 2000 to January 2015, were included patients over 15 years of age with relapsed ALL who received chemotherapy rescue schemes of own protocols called LAL or LAMMP-A; we reviewed their clinical, electronic and tracking sheets designed for hematologists of the Service. The complete remission was evaluated at day 28 postchemotherapy and haematological and non-haematological toxicity was evaluated according to WHO classification.
Results: A total of 48 patients were evaluable, 12 treated with LAL and 36 treated with LAMMP-A; they were no differences in sex, age, risk, leukocyte count, bone marrow blasts, lactic dehydrogenase and time to relapse (p≥0.4). The overall complete remission was 28%, in the LAMMP-A group, the complete remission was attained in 23% and was 63% in those treated with LAL (p=0.021). Sex showed influence on the complete remission in patients treated with LAMMP A with remission of 21% of men and 77% of women (p =0.001), blasts count less than 50% and the risk of leukemia also showed prognostic influence on complete remission in the patientes receiving the LAL protocol (p≤0.024). The only predictor of survival was the RC. The treatment related mortality was 22%, with no differences in terms of hematologic and non hematologic toxicity and hospitalization days.
Conclusions: Chemotherapy rescue schedules used in CMN 20 de Noviembre, ISSSTE, in Mexico City, offer complete remission similar to those reported in the literature, with TRM ant toxicity also similar, LAL scheme has a higher frequency of complete remission when compared with LAMMP-A scheme, finding no difference in relation to safety and treatment related mortality.

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