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Methotrexate plus L‐asparaginase. An active combination for children with acute nonlymphocytic leukemia
Author(s) -
Hudson Melissa M.,
Dahl Gary V.,
Kalwinsky David K.,
Pui ChingHon
Publication year - 1990
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19900615)65:12<2615::aid-cncr2820651202>3.0.co;2-x
Subject(s) - medicine , methotrexate , leukemia , stomatitis , gastroenterology , refractory (planetary science) , bone marrow , toxicity , asparaginase , amsacrine , chemotherapy , complete remission , lymphoblastic leukemia , physics , astrobiology , etoposide
Forty‐one children with refractory acute nonlymphocytic leukemia (ANLL) were treated from March 1975 to February 1979 with a schedule‐dependent combination of methotrexate (MTX) and L‐asparaginase. Intravenous (IV) MTX was followed 24 hours later by IV L‐asparaginase (10,000 units [U]/m 2 ). The MTX dose was started at 60 to 100 mg/m 2 and was escalated by 20 to 40 mg/m 2 as tolerated. This sequence was repeated every 7 to 10 days. Eight patients (20%) achieved a complete remission (CR) and six others had a partial response (PR), with clearance of blasts from the peripheral blood and reduction of bone marrow blasts to less than 25% of nucleated marrow cells. Responding patients received a median maximum MTX dose of 120 mg/m 2 (range, 60 to 220 mg/m 2 ). The median number of courses required to achieve a CR was 6 (range, 2 to 13 courses). Toxicity consisted of allergic reactions to L‐asparaginase (n = 12), stomatitis (n = 6), minimal elevation of hepatic enzymes (n = 2), and hyperglycemia (n = 1). Treatment was given on an outpatient basis in 95% of all courses. The data indicate that this combination therapy has antileukemic activity and is relatively nontoxic in childhood ANLL.