A single, high dose of idarubicin combined with cytarabine as induction therapy for adult patients with recurrent or refractory acute lymphoblastic leukemia Journal Article
| Authors: | Weiss, M. A.; Aliff, T. B.; Tallman, M. S.; Frankel, S. R.; Kalaycio, M. E.; Maslak, P. G.; Jurcic, J. G.; Scheinberg, D. A.; Roma, T. E. |
| Article Title: | A single, high dose of idarubicin combined with cytarabine as induction therapy for adult patients with recurrent or refractory acute lymphoblastic leukemia |
| Abstract: | BACKGROUND. The majority of adult patients who are treated for lymphoblastic disease will either develop recurrent disease or will be refractory to their initial therapy. One option for patients with recurrent/refractory disease is to administer a reinduction regimen that employs a dose-intense combination of anthracycline and cytarabine. These salvage regimens are relatively distinct from the traditional vincristine/prednisone-based programs that are used typically as primary induction therapy. The authors studied a regimen that contained high-dose cytarabine and a single high dose of idarubicin as salvage induction therapy for patients with recurrent or refractory lymphoblastic disease. METHODS. Twenty-nine previously treated adult patients with recurrent or refractory acute lymphoblastic leukemia were treated with a new intensive regimen. Eight patients had primary refractory disease. Twenty-one patients had recurrent disease, and 16 of these patients developed recurrent disease while they were still receiving their primary therapy. The treatment regimen consisted of cytarabine 3.0 g/m2 by 3 -hour infusion daily for 5 days and idarubicin 40 mg/m2 given as a single dose on Day 3. Filgrastim (granulocyte-colony stimulating factor) 5 μg/kg administered subcutaneously every 12 hours was started on Day 7 and was continued until the absolute neutrophil count was > 5000/μL. Response was assessed using standard criteria. RESULTS. There were 11 complete responses (38%; 95% confidence interval, 20-56%). Four patients subsequently underwent allogeneic bone marrow transplantation. Moderate but acceptable toxicity was observed given the severely myelosuppressive nature of the regimen. There was only one treatment- related death (3%). Two patients, both with significant prior exposure to anthracyclines, suffered reductions in left ventricular function to the 20-30% range during episodes of severe systemic infection. After recovery from infection, the ejection fraction in one patient improved to 50%. CONCLUSIONS. The authors conclude that this regimen has moderate activity and a relatively low incidence of mortality for this high-risk group of patients. This regimen may be most suitable for patients who can undergo potentially curative allogeneic bone marrow transplantation if they achieve a complete response. © 2002 American Cancer Society. |
| Keywords: | adult; clinical article; treatment outcome; aged; middle aged; survival analysis; salvage therapy; cancer combination chemotherapy; drug efficacy; heart left ventricle failure; cytarabine; methotrexate; drug megadose; recurrent cancer; antineoplastic agent; infection; neoplasm recurrence, local; bone marrow suppression; antineoplastic combined chemotherapy protocols; allogenic bone marrow transplantation; drug effect; dose-response relationship, drug; cancer mortality; acute lymphoblastic leukemia; fever; confidence interval; neutrophil; drug response; drug infusion; cognition; idarubicin; recombinant granulocyte colony stimulating factor; convalescence; heart; drug induced disease; hematemesis; refractory; recurrent; conjunctivitis; heart ejection fraction; leukemia, lymphocytic, acute; humans; human; male; female; priority journal; article; adult acute lymphoblastic leukemia |
| Journal Title: | Cancer |
| Volume: | 95 |
| Issue: | 3 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2002-08-01 |
| Start Page: | 581 |
| End Page: | 587 |
| Language: | English |
| DOI: | 10.1002/cncr.10707 |
| PUBMED: | 12209751 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 14 November 2014 -- Source: Scopus |
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