Lineage specific treatment of adult patients with acute lymphoblastic leukemia in first remission with anti-B4-blocked ricin or high-dose cytarabine : Cancer and Leukemia Group B Study 9311
✍ Scribed by Ted P. Szatrowski; Richard K. Dodge; Carol Reynolds; Carol A. Westbrook; Stanley R. Frankel; Jeffrey Sklar; Carleton C. Stewart; David D. Hurd; Jonathan E. Kolitz; Enrique Velez-Garcia; Richard M. Stone; Clara D. Bloomfield; Charles A. Schiffer; Richard A. Larson
- Publisher
- John Wiley and Sons
- Year
- 2003
- Tongue
- English
- Weight
- 111 KB
- Volume
- 97
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
Background:
Anti-b4-blocked ricin is an immunotoxin comprised of an anti-cd19 murine monoclonal antibody (b4) conjugated to blocked ricin, which has cytotoxic activity in patients with lymphoid malignancies.
Methods:
Adults with untreated acute lymphoblastic leukemia (all) were treated with a previously developed and tested chemotherapeutic regimen. patients with cd19 positive all were given anti-b4-blocked ricin as 2 7-day continuous infusions 1 week apart. patients with cd19 negative all received high-dose cytarabine. serial polymerase chain reaction (pcr) assays of bcr-abl, immunoglobulin heavy chain (igh), and t-cell receptor (tcr) genes were used to measure the impact of lineage specific intensification treatment on minimal residual disease.
Results:
Eighty-two adults were enrolled, and 78 were eligible. the median age was 34 years (range, 17-81 years). sixty-six patients (85%) achieved complete remission. forty-six patients received the anti-b4-blocked ricin, which generally was well tolerated; 80% were able to receive both courses. the most common toxicity was asymptomatic transient elevation of liver function tests in 72% of patients. lymphopenia occurred in 46% of patients. two patients developed antibodies to the anti-b4-blocked ricin. molecular monitoring before and after the experimental course of intensification did not show a consistent change in the number of leukemia cells remaining, and the immediate posttreatment pcr studies did not correlate with remission duration.
Conclusions:
Intensification therapy with anti-b4-blocked ricin is feasible for patients with cd19 positive all, although there is little evidence of an additional clinical benefit from the anti-b4-blocked ricin. cancer 2003;97:1471-80.