Low-Dose Aclacinomycin and Intermediate-Dose Cytosine Arabinoside in Relapsed and Refractory Acute Myelogenous Leukemia
Nineteen patients with relapsed or refractory acute myelogenous leukemia were treated with escalating doses of aclacinomycin (ACLA 20–30 mg/m2 daily for 5 days) and intermediate-dose cytosine arabinoside (Ara-C 1 g/m2 twice daily for 4 days). Most patients had received previous therapy with high- or intermediate-dose Ara-C plus mitoxantrone (HAM, IAM) and TAD (6-thioguanine, standard-dose cytosine arabinoside, and daunorubicin). Four patients had had repeated relapses and another three were treated for primary treatment failure following induction with HAM or I AM.
Twelve patients (63%) responded: nine (47%) entered complete remission (CR) and three (16%) had a partial remission. None of the patients refractory to HAM or IAM went into CR. Side effects from this treatment were generally mild. However, urinary tract toxicity with hematuria and dysuria turned out to be dose limiting, since all patients receiving ACLA 30 mg/m2 experienced grade 2–3 toxicity (WHO). These side effects were mild when ACLA was used at 20 mg/m2 (grade 1–2 toxicity only, in 21% of patients). Consequently, the study was continued with a fixed ACLA dose of 20 mg/m2 that was found to be safe and well tolerated. The overall CR rate of 47% compares well with other salvage protocols and ACLA combinations, arguing for further evaluation of this therapeutic approach.
KeywordsAcute Myeloid Leukemia Complete Remission Acute Myelogenous Leukemia Complete Remission Rate Cytosine Arabinoside
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