治疗成人新诊断的急性淋巴细胞白血病（ALL）可能过于毒性或者资源密集。为了解决这个问题，我们进行了一项DA-EPOCH剂量调整阿霉素、泼尼松、长春新碱、环磷酰胺和多柔比星（DA-EPOCH）的二期研究。如果存在Ph+病则添加伊马替尼或去他替尼；如果CD20+则添加利妥昔单抗。共有53位患者纳入评估，其中28位患有Ph+疾病，25位患有Ph-疾病。所有患者都有≥1个高危临床特征。在4个周期内，Ph+ ALL患者中有71％，Ph- ALL患者中有64％的可测残余疾病阳性转阴。中位总体生存期（OS）为49个月，2年生存率为71％。47名达到形态学缓解的患者中，中位无复发生存期（RFS）为24个月，2年RFS为57％。早期死亡率为2％。总之，DA-EPOCH对于成人ALL产生的深入和持久的缓解与某些资源密集策略相当，但治疗相关死亡率较低。

Treatments for adults with newly-diagnosed acute lymphoblastic leukemia (ALL) may be prohibitively toxic and/or resource-intense. To address this, we performed a phase II study of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-EPOCH). Imatinib or dasatinib was added for Ph + disease; rituximab was added when CD20+. Fifty-three patients were evaluable: 28 with Ph + disease, and 25 with Ph-. All patients had ≥1 high-risk clinical feature. Measurable residual disease-negativity by multiparameter flow cytometry within 4 cycles was achieved in 71% in patients with Ph + ALL and 64% in Ph - ALL. Median overall survival (OS) was 49 months, with a 2-year OS of 71%. Median relapse-free survival (RFS) in the 47 patients that attained morphologic remission was 24 months, with a 2-year RFS of 57%. Early mortality was 2%. In summary, DA-EPOCH yields deep and durable remissions in adults with ALL comparable to some resource-intense strategies but with a low rate of treatment-related death.