VAPA10: A Treatment Program for Acute Myelocytic Leukemia

  • R. J. Mayer
  • H. J. Weinstein
  • D. S. Rosenthal
  • F. S. Coral
  • D. G. Nathan
  • E. FreiIII
Conference paper
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 26)

Abstract

During the past decade, the combination of an anthracycline and continuous infusion cytosine arabinoside chemotherapy has been associated with an increase in the complete response rate of patients under age 60 having acute myelocytic leukemia (AML) from 35%-55% (Carey et al. 1975; Clarkson et al. 1975) to approximately 75% (Evans et al. 1975; Gale 1979; Haghbin et al. 1977; Preisler et al. 1979; Rees and Hayhoe 1978; Yates et al. 1973). This encouraging advance, however, has not led to prolonged periods of remission and indefinite survival as seen in childhood acute lymphocytic leukemia. The median duration of complete remission in most recent studies in AML is in the range of 12-14 months (Armitage and Burns 1976; Evans et al. 1975; Haghbin et al. 1977; Moreno et al. 1977; Peterson and Bloomfield 1977; Preisler et al. 1979; Rees and Hayhoe 1978; Spiers et al. 1977). In early 1976 a therapeutic program (VAPA 10 protocol) was initiated in an attempt to overcome the causes of relapse in patients with AML. It was postulated that the high failure rate in AML patients in complete remission might be the result of inadequate cytoreduction during the maintenance period, the development of drug resistance, the presence of “sanctuaries” into which effective chemotherapy could not penetrate, and the presence of a mutant myeloid progenitor cell which over a period of time would progressively replace or even suppress the growth of the differentiated product of normal hematopoiesis. It was appreciated that if the latter possibility were true, it would be unlikely that intensive chemotherapy would have any longterm beneficial effect in patients with AML and that the only rational therapeutic option would be replacement of these progenitor cells through a maneuver such as bone marrow transplantion. Others are presently testing the utility of marrow transplantation in patients with AML shortly after complete remission is obtained (Blume et al. 1980; Powles et al. 1980; Thomas et al. 1979).

Keywords

Methotrexate Cardiomyopathy Prednisone Prednisolone Cytosine 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1981

Authors and Affiliations

  • R. J. Mayer
  • H. J. Weinstein
  • D. S. Rosenthal
  • F. S. Coral
  • D. G. Nathan
  • E. FreiIII

There are no affiliations available

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