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i
INDUCTION THERAPY IN RELAPSE ADULT ACUTE
LYMPHOBLASTIC LEUKEMIA
By
Ravindra Patel
A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements of the Degree
MASTER OF SCIENCE
(CLINICAL AND BIOMEDICAL INVESTIGATIONS)
December 2013
Object Description
| Title | Induction therapy in relapse adult acute lymphoblastic leukemia |
| Author | Patel, Ravindra |
| Author email | drravindrapatel@gmail.com;ravindrp@usc.edu |
| Degree | Master of Science |
| Document type | Thesis |
| Degree program | Clinical and Biomedical Investigations |
| School | Keck School of Medicine |
| Date defended/completed | 2013-10-21 |
| Date submitted | 2013-11-18 |
| Date approved | 2013-11-18 |
| Restricted until | 2015-11-18 |
| Date published | 2015-11-18 |
| Advisor (committee chair) | Pullarkat, Vinod |
| Advisor (committee member) |
Aldoss, Ibrahim Azen, Stanley P. |
| Abstract | Background: Currently available chemotherapeutic treatment for relapse/refractory acute lymphoblastic leukemia (ALL) helps to achieve complete remission (CR) in only one third of the patients. The definitive treatment for ALL is allogeneic hematopoietic stem cell transplant (HSCT) which can be used only in patients who achieved complete remission with the chemotherapy. We did the study to explore possibilities for better survival by using other possible chemotherapeutic regimens in relapsed/refractory ALL patients. ❧ Methods: Patients with ALL who relapsed or were refractory to chemotherapy, age range of 17 to 55 years, Karnofsky performance status of > 50%, and adequate hepatic and renal function were eligible for the study. The primary objective of the study was to achieve higher CR rate after the two phases of induction therapy as compared to standard of care. Secondary objectives were to achieve longer LFS (Leukemia free survival), measure regimen toxicity and decrease number of days required for neutrophil count recovery after each cycle of induction as compared to current chemotherapy for relapsed/refractory ALL patients. In an effort to improve the CR rate in adults ALL cases, a modified regimen was derived from pediatric Berlin-Frankfurt-Muenster (BFM)-85 protocol, with addition of a continuous infusional phase II induction followed by consolidation with alternating monthly cycles. ❧ Results: In this study, we have included the outcome of 19 patients treated prospectively on the study, as well as a subsequent cohort of 31 patients treated off the study. Thirteen out of nineteen (68%) patients from the initial prospective study achieved CR, and the median overall survival of these 13 CR patients was 10.3 months. The median survival and LFS of all 19 patients were 5.6 and 4.3 months respectively. The regimen was well-tolerated and no grade 4 non-hematological toxicity was observed. Of the 31 patients treated off the study and analyzed retrospectively, 16 (52%) achieved CR. After including all 50 patients, 29 achieved CR (58%). ❧ Conclusion: The regimen used in this trial helps to achieve higher CR than the current chemotherapeutic regimen for relapse/refractory ALL and helps to use allogeneic-HSCT as a definitive treatment in these patients. |
| Keyword | acute lymphoblastic leukemia; adult; relapse; reinduction |
| Language | English |
| Format (imt) | application/pdf |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m |
| Contributing entity | University of Southern California |
| Rights | Patel, Ravindra |
| Physical access | The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given. |
| Repository name | University of Southern California Digital Library |
| Repository address | USC Digital Library, University of Southern California, University Park Campus MC 7002, 106 University Village, Los Angeles, California 90089-7002, USA |
| Repository email | cisadmin@lib.usc.edu |
| Filename | etd-PatelRavin-2155.pdf |
| Archival file | uscthesesreloadpub_Volume8/etd-PatelRavin-2155.pdf |
Description
| Title | Page 1 |
| Repository email | cisadmin@lib.usc.edu |
| Full text | i INDUCTION THERAPY IN RELAPSE ADULT ACUTE LYMPHOBLASTIC LEUKEMIA By Ravindra Patel A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements of the Degree MASTER OF SCIENCE (CLINICAL AND BIOMEDICAL INVESTIGATIONS) December 2013 |
