TREATMENT OF POOR RISK ACUTE-LEUKEMIA WITH SEQUENTIAL HIGH-DOSE ARA-C AND ASPARAGINASE

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  • 1 January 1984
    • journal article
    • research article
    • Vol. 63  (3) , 694-700
Abstract
A therapeutic program was developed for the treatment of patients with acute nonlymphocytic leukemia (ANLL) refractory to conventional doses of ARA-C [cytosine arabinoside], as well as patients with high risk ANLL and advanced acute lymphocytic leukemia (ALL). Treatment consisted of 3-h i.v. infusins of 3 g/sq m of ARA-C given at 12-h intervals for 4 doses, followed by 6000 IU/sq m ASNase [asparaginase] given i.m. at hour 42. The same schedule was repeated on day 8. In 32 induction attempts, only 4 patients proved to be truly refractory, i.e., failed to achieve substantial leukemia cell cytoreduction. Complete remissions were achieved with HiDAC .fwdarw. ASNase in 9 of 13 patients with refractory ANLL, 6 of 9 patients with antecedent hematologic disordres, and 3 of 10 patients with advanced ALL. These include 9 of 14 patients who had failed induction or who had relapsed on active ARA-C therapy and 6 of 8 patients who had no prior exposure to ARA-C. The median duration of unmaintained remission in ANLL was 5 mo. In a patient with CNS leukemia, there was clearance of CSF blasts without intrathecal therapy, suggesting a role for HiDAC in CNS prophylaxis. In general, toxicity was tolerable and reversible. These data suggest that HiDAC .fwdarw. ASNase is an exceptionally effective and well tolerated regimen in leukemia patients with antecedent hematologic disorders and in those refractory to conventional doses of ARA-C.