Premium
Ifosfamide with mesna uroprotection and etoposide in recurrent, refractory acute leukemia in childhood: A pediatric oncology group study
Author(s) -
Bernstein Mark L.,
Michael Whitehead V.,
Devine Susan,
Grier Holcombe,
Kung Faith,
Krischer Jeffrey,
Dreyer Zoanne,
Bell Beverly,
Land Vita,
Buchanan George R.,
Pratt Charles
Publication year - 1993
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(19930901)72:5<1790::aid-cncr2820720545>3.0.co;2-4
Subject(s) - ifosfamide , mesna , etoposide , medicine , chemotherapy , nitrogen mustard , refractory (planetary science) , surgery , urology , cyclophosphamide , astrobiology , physics
Background . Ifosfamide has previously been shown to be active as a single agent and in combination with doxorubicin, etoposide, and teniposide in pediatric solid tumors and adult acute leukemia. The authors performed a dose‐escalation trial of ifosfamide with a fixed dosage of etoposide, with mesna uroprotection, in children with multiply recurrent acute leukemia. Methods . Chemotherapy was administered daily for 5 days. Etoposide 100 mg/m 2 was followed by ifosfamide at an initial dosage of 1.6 g/m 2 . The ifosfamide was escalated in 20% increments to the maximum tolerated dosage in cohorts of three patients. Mesna 400 mg/m 2 was given immediately before the ifosfamide and then at 3 and 6 hours after ifosfamide in the initial patients. Subsequent patients were treated with mesna 400 mg/m 2 just before ifosfamide, and then every 2 hours to a total dosage equal to the ifosfamide dosage. Results . Forty‐four heavily pretreated patients were entered on study. Forty were evaluable for toxicity and 36 for response as well. The maximum tolerated dosage of ifosfamide was 4.0 g/m 2 /d for 5 days (20 g/m 2 /course). Overall, 10 patients achieved complete remission, and 3 achieved partial remission. Remissions were brief, although four patients went on to bone marrow transplant while in remission. One patient is still alive. Conclusions . The combination of etoposide and ifosfamide with mesna uroprotection showed promising activity in children with multiply recurrent acute leukemia.