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S-HAM Salvage Therapy of Relapsed and Refractory AML Followed by Interleukin 2 Postremission Therapy

  • W. Hiddemann
  • M. Unterhalt
  • M. Kemper
  • E. Schleyer
  • P. Schönrock-Nabulsi
  • L. Uharek
  • M. Fromm
  • D. Braumann
  • M. Planker
  • U. Kubicka
  • J. Karow
  • S. Lange
  • C. Tirier
  • B. Wörmann
  • C. Sauerland
  • A. Heinecke
  • Th. Büchner
  • German AML Cooperative Group
Conference paper
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 37)

Abstract

A preceding study of the German AML Cooperative Group with an age adjusted randomized comparison of high-dose versus intermediate-dose Cytosine Arabinoside (AraC) as part of the S-HAM protocol indicated a significantly higher antileukemic activity of AraC at a dose of 3.0 vs. 1.0 g/m2 per single dose predominantly in patients with early relapse and second or subsequent recurrence of disease but also an increased rate of early deaths. Based on these results the current study aimed at taking advantage of the high antineoplastic activity of high dose AraC but to reduce the associated infectious complications by the posttherapeutic application of G-CSF. AraC dose was adjusted to disease status and age in that patients below 60 years of age with early relapse and second or subsequent recurrence received AraC at a dose of 3.0 g/m2 while later first relapses and older patients were treated with AraC 1.0 g/m2. Immediately after the end of S-HAM G-SCF was applied at a dose of 5 ug/kg until neutrophil recovery. Patients achieving a complete remission underwent randomization for postremission therapy with Interleukin 2 (IL2) 18 × 106 U/m2/d over 5 days by cont. infusion or observation only. IL2 therapy was repeated at 4 week intervals. At the present time 53 patients have been entered into the study and 38 are evaluable for response and toxicity. 22 cases (58%) obtained a CR, 9 patients (24%) were NR and 7 cases (18%) died during the first six weeks (early deaths). Neutrophil recovery occured at a median of 28 days and was significantly shorter as compared to the preceding S-HAM therapy without G-CSF support. 8 patients have been randomized for IL2 postremission therapy. These results indicate a significant improvement of remission rate and a reduction of lethal complications by G-CSF administration as compared to the historic control. Further recruitment and a longer observation time are needed to substantiate these findings and to assess the impact of IL2 on remission duration.

Keywords

Acute Myeloid Leukemia Acute Leukemia Cytosine Arabinoside Remission Duration Neutrophil Recovery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • W. Hiddemann
    • 1
  • M. Unterhalt
    • 1
  • M. Kemper
    • 2
  • E. Schleyer
    • 1
  • P. Schönrock-Nabulsi
    • 3
  • L. Uharek
    • 4
  • M. Fromm
    • 5
  • D. Braumann
    • 6
  • M. Planker
    • 7
  • U. Kubicka
    • 8
  • J. Karow
    • 9
  • S. Lange
    • 10
  • C. Tirier
    • 11
  • B. Wörmann
    • 1
  • C. Sauerland
    • 12
  • A. Heinecke
    • 12
  • Th. Büchner
    • 2
  • German AML Cooperative Group
  1. 1.Department of Hematology and OncologyUniversity of GöttingenGöttingenGermany
  2. 2.Department of Hematology and OncologyUniversity of MünsterMünsterGermany
  3. 3.Department of Hematology and OncologySt. Georg HospitalHamburgGermany
  4. 4.Department of Hematology and OncologyUniversity of KielGermany
  5. 5.Department of Hematology and OncologyTechnical University of MünchenMünchenGermany
  6. 6.Department of Internal MedicineHospital AltonaHamburgGermany
  7. 7.Department of Internal MedicineHospital KrefeldKrefeldGermany
  8. 8.Central Hospital St. JürgenBremenGermany
  9. 9.Department of Internal Medicine IIIHospital DürenDürenGermany
  10. 10.Department of Hematology and OncologyHospital HammHammGermany
  11. 11.Department of Internal MedicineHospital Essen-WerdenEssen-WerdenGermany
  12. 12.Department of BiostatisticsUniversity of MünsterMünsterGermany

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