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RESULTS OF INDUCTION AND CONSOLIDATION TREATMENT WITH INTERMEDIATE AND HIGH‐DOSE ARA‐C AND m‐AMSA CONTAINING REGIMENS IN PATIENTS WITH PRIMARILY FAILED OR RELAPSED ACUTE LEUKEMIA AND NON‐HODGKIN'S LYMPHOMA
Author(s) -
Peters W.G.,
Willemze R.,
Colly L.P.
Publication year - 1986
Publication title -
scandinavian journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0036-553X
DOI - 10.1111/j.1600-0609.1986.tb01587.x
Subject(s) - medicine , amsacrine , gastroenterology , prednisone , methotrexate , lymphoma , vincristine , leukemia , etoposide , chemotherapy , cyclophosphamide
SUMMARY Fifty two patients (aged 15–57 years) with primarily failed and relapsed acute myelogenous (AML) or lymphoblastic leukemia (ALL) and with high‐grade non‐Hodgkin's lymphoma (NHL) have been treated with intermediate dose cytosine arabinoside. Ara‐C (1 g/m 2 q 12 h × 12) with 3 d of m‐AMSA, 115 mg/m 2 daily was given to 18 patients, with daunorubicin (3 patients) 45 mg/m 2 daily for 3 days to 3 patients and in 14 patients 1 day of m‐AMSA (115 mg/m 2 ) was administered. In 17 patients ara‐C was combined with VP16.213 120 mg/m 2 i v. on day 1 and 7, m‐AMSA 115 mg/m 2 i.v. on day 1 and 7 and prednisone 60 mg/m 2 orally on days 1–7, these patients received methotrexate 10 mg/m 2 intrathecally on day 1. Thirty three patients obtained a complete remission (AML 18/24, ALL 7/9, NHL 8/18). 17 patients received consolidation treatment with 1–3 courses comprising 4 d of ara‐C (3 g/m 2 q 12 h × 8). in 9 patients combined with m‐AMSA 115 mg/m 2 i.v. on day 5 and in 8 patients with VP16.213 120 mg/m 2 on day 1 and 5, m‐AMSA 115 mg/m 2 on day 1 and 5 and prednisone 60 mg/m 2 orally days 1–5 and methotrexate 10 mg/m 2 intrathecally on day 1. Three patients underwent allogeneic bone marrow transplantation, all other patients received no further treatment. Median remission duration was 3 months for those patients who received no treatment after remission induction. Five patients who received consolidation treatment relapsed after 4 months (2 ALL), 6 months (NHL), 9 months (AML) and 16 months (AML). Thirteen patients still are in remission at 2+ ‐ 21+ months. In addition to vomiting, fever, skin rashes, conjunctivitis and myalgia toxicity included diarrhoea in 35.8 per cent of patients and 10 patients developed diffuse interstitial pneumonia without clear cause and probably due to ara‐C administration. Fifty‐eight septicemic episodes were observed, in 65% caused by Streptococcus viridans. The pancytopenic period ranged from 16–25 days (median 21 days) after the remission induction and 14–21 days (median 19 days) after the consolidation course. Intermediate dose ara‐C is active in primary refractory and relapsed acute leukemia and lymphoblastic non‐Hodgkin's lymphoma. Side effects are acceptable although interstitial lung‐involvement remains to be further investigated.