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Outcome of patients with acute lymphoblastic leukemia (ALL) following induction therapy with a modified (pulsed dexamethasone rather than continuous prednisone) UKALL XII/ECOG E2993 protocol at Tawam Hospital, United Arab Emirates (UAE)

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Abstract

This retrospective data analysis examined the outcome of 99 acute lymphoblastic leukemia (ALL) patients treated at Tawam Hospital between January 2000 and December 2009. Sixteen patients were treated before June 2002, and 83 patients were treated from June 2002. A modified form of UKALL XII/ECOG E2993 with pulsed dexamethasone in induction phase one (modified UKALL) was the main therapy from June 2002 (71/83). The median age was 28 years. Fifty-eight percent had pre-B ALL where 36 % of them were Philadelphia chromosome-positive (Ph+). Overall, complete remission (CR) rate was 86.7 % which was significantly inferior for patients with white blood cell count 30–100 × 109/l (p = 0.009), therapy before June 2002 (p = 0.02), pregnancy (p = 0.005), CNS leukemia (p = 0.028), and unknown karyotype (p = 0.004). With a median follow-up of 11.8 months (0.49–126 months), the estimated overall survival (OS) and event-free survival (EFS) at 3 years were 50.6 and 28.7 %, respectively. OS and EFS were significantly inferior for patients not in CR after induction, age >20 years, Ph+, unknown karyotype and therapy before June 2002. In addition, CR, OS and EFS were significantly superior (p = 0.004, p < 0.001 and p = 0.001, respectively) for therapy with our modified UKALL protocol compared to Tawam protocol (main therapy before June 2002). In conclusion, the outcome of treatment for ALL at our institute is encouraging with significant improvement in the outcome of older adolescents and young adults when using high-intensity chemotherapy. This suggests that such an approach is feasible in developing countries in spite of some limitations including lack of stem cell transplantation service.

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Acknowledgments

This work was supported by grants from Research Affairs, United Arab Emirates University. The authors thank the staff at The National Cancer Registry, and the Medical Record Department, at Tawam Hospital, Al Ain, UAE. The authors would like to thank Mrs. Mary Kutty Jacob and to the medical students, FMHS, UAEU, who participated in the data collection. The authors would like to thank DR. David Spence, Consultant Clinical Hematology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates and Ms. Ihasan Abdur-rahman, research assistant, Faculty of Medicine and Health Sciences United Arab Emirates University, for help with English language editing.

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates

    Inaam B. Hassan

  2. Department of Oncology, Tawam Hospital, Al Ain, United Arab Emirates

    Inaam B. Hassan, Jorgen Kristensen & Hussain Alizadeh

  3. Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates

    Roos Bernsen

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  1. Inaam B. Hassan
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Correspondence to Inaam B. Hassan.

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Hassan, I.B., Kristensen, J., Alizadeh, H. et al. Outcome of patients with acute lymphoblastic leukemia (ALL) following induction therapy with a modified (pulsed dexamethasone rather than continuous prednisone) UKALL XII/ECOG E2993 protocol at Tawam Hospital, United Arab Emirates (UAE). Med Oncol 30, 519 (2013). https://doi.org/10.1007/s12032-013-0519-6

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