Cytarabine with high-dose mitoxantrone induces rapid complete remissions in adult acute lymphoblastic leukemia without the use of vincristine or prednisone Journal Article


Authors: Weiss, M.; Maslak, P.; Feldman, E.; Berman, E.; Bertino, J.; Gee, T.; Megherian, L.; Seiter, K.; Scheinberg, D.; Golde, D.
Article Title: Cytarabine with high-dose mitoxantrone induces rapid complete remissions in adult acute lymphoblastic leukemia without the use of vincristine or prednisone
Abstract: Purpose: To evaluate the efficacy and safety of a new induction regimen for adult acute lymphoblastic leukemia (ALL) that does not contain vincristine or corticosteroids. Patients and Methods: Thirty-seven adult patients with newly diagnosed ALL and lymphoblastic lymphoma were treated with a dose-intense induction regimen. This regimen was designed to increase the fraction of patients achieving an early complete remission (CR) in an attempt to increase long-term disease-free survival. The induction regimen was cytarabine (Ara-C) 3 g/m2/d for 5 days and mitoxantrone 80 mg/m2 as a single dose on day 3. Granulocyte colony-stimulating factor (G-CSF) 200 μg/m2/d beginning on day 7 was used to promote early myeloid recovery. Results: There were 31 CRs (84%). Median time to CR was 34 days, median hospital stay was 28 days, and the median number of days with a neutrophil count less than 500/μL was 18. There were three patients with resistant disease who experienced treatment failure and three early deaths from sepsis. Four patients with Philadelphia chromosome-positive (Ph+) ALL achieved hematologic and cytogenetic CRs. Conclusion: This dose-intense induction regimen produced a high incidence of CRs with acceptable toxicity without the use of vincristine or corticosteroids. Comparisons with our prior vincristine/prednisone-based induction regimen (the L-20 protocol) suggest that patients treated on the current study were more likely to achieve a CR and that they achieved this remission earlier than patients treated with a traditional four-drug (vincristine, prednisone, doxorubicin, and cyclophosphamide) induction regimen.
Keywords: adolescent; adult; clinical article; controlled study; aged; disease-free survival; middle aged; prednisone; dose response; cytarabine; antineoplastic combined chemotherapy protocols; vincristine; acute lymphoblastic leukemia; survival time; hospitalization; cancer regression; mitoxantrone; remission induction; sepsis; leukocyte count; granulocyte colony stimulating factor; granulocyte colony-stimulating factor; humans; human; male; female; priority journal; article; leukemia, lymphocytic, acute, l2
Journal Title: Journal of Clinical Oncology
Volume: 14
Issue: 9
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1996-09-01
Start Page: 2480
End Page: 2485
Language: English
PUBMED: 8823326
PROVIDER: scopus
DOI: 10.1200/JCO.1996.14.9.2480
DOI/URL:
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. David Golde
    103 Golde
  2. Joseph Bertino
    257 Bertino
  3. Peter Maslak
    166 Maslak
  4. Mark Weiss
    80 Weiss
  5. Ellin Berman
    89 Berman