Intermediate-dose cytosine arabinoside and amsacrine an effective regimen with low toxicity in refractory acute nonlymphocytic leukemia

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Abstract
Results of remission induction therapy in refractory acute nonlymphocytic leukemia (ANLL) has been improved since the introduction of high-dose cytosine arabinoside. However, the toxicity of these regimens attributes to an early death rate of about 20% to 30%. The authors treated 37 poor-risk patients with ANLL with intermediate-dose cytosine arabinoside and amsacrine for remission induction. One consolidation course and no maintenance therapy was given. Eleven of 19 patients with a first relapse entered complete remission (58%); ten of 15 patients in this group older than 50 years were complete responders (67%). Median duration of second remission was 8.2 months (range, 2--14). Three of 13 patients with primarily resistant disease had a complete remission (23%), but there was no response in five patients with a myeloid blastic phase of chronic myelogenous leukemia. Side effects of this remission induction regimen were mild; no cardiac, pulmonary, or central nervous system toxicity was observed. Five patients (14%) died during the remission induction phase, three from complications during aplasia and two from refractory leukemia. Cancer 65:1891–1894, 1990.