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.
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© 1996 Springer-Verlag Berlin Heidelberg
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Hiddemann, W. et al. (1996). S-HAM Salvage Therapy of Relapsed and Refractory AML Followed by Interleukin 2 Postremission Therapy. In: Hiddemann, W., et al. Acute Leukemias V. Haematology and Blood Transfusion / Hämatologie und Bluttransfusion, vol 37. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78907-6_31
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DOI: https://doi.org/10.1007/978-3-642-78907-6_31
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-78909-0
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