The hyper-CVAD regimen in adult acute lymphocytic leukemia

The hyper-CVAD regimen is an active, dose-intensive program for adult ALL. This regimen is also active in other lymphoid malignancies, such as lymphoblastic lymphoma, Burkitt's disease, mantle cell lymphoma, multiple myeloma, and chronic lymphocytic leukemia. The current modifications to the hyper-CVAD regimen include 1. Offering LAFR to older patients undergoing induction therapy (based on results obtained in older patients with acute myelogenous leukemia receiving induction therapy in the LAFR). 2. Incorporating high-dose anthracyclines early during induction-consolidation. This modification is based on the results of Todeschini et a1 using high-dose daunorubicin with an estimated 6-year event-free survival of 55%. 3. Addition of rituximab to CD20-positive ALL, including mature B-cell ALL. 4. Including early and late intensifications with two courses of hyper-CVAD and MTX plus asparaginase at months 6 and 18 during maintenance and prolonging POMP maintenance to 3 years. This modification is aimed at reducing the occurrence of late relapses. 5. Development of hyper-CVAD plus STI-571 combinations in Ph-positive ALL. 6. Modifying CNS prophylaxis to six IT treatments for low-risk patients, eight IT treatments for other patients, and 16 IT treatments for mature B-cell ALL and for patients presenting with CNS disease. 7. Future addition of agents discovered to be active against ALL (e.g., compound GW506U78, CAMPATH-1H).