Cyclophosphamide-asparaginase-vincristine-prednisone induction therapy in childhood acute lymphocytic and nonlymphocytic leukemia

Abstract

A remission-induction regimen for childhood leukemia using cyclophosphamide, asparaginase, vinnistine, a n d prednisone (CAVP) was compared to standard vincristine-prednisone (VP) induction. The more intensive regimen was associated with a lower complete remission rate (81% vs 93%) and a higher early death rate from infection (15% vs 5 % ) for acute lymphocytic leukemia. In contrast, complete remission was achieved in 58% of children with acute nonlymphocytic leukemia treated with CAVP compared to 18% for VP. Early death rates were similar (27% vs 25%). These observations corroborate previous studies in childhood nonlymphocytic leukemia showing activity for asparaginase. Preliminary analysis of remission duration and survival for responders shows no advantage for those who survived the more intensive induction.

Impact of the timing of triple intrathecal therapy on remission induction in childhood acute lymphoblastic leukemia: A pediatric oncology group study

“…Eva Hvizdala, MD chemotherapy (methotrexate, hydrocortisone, cytosine arabinoside) starting on day 1 of treatment were added to systemic induction therapy in a regimen (Arm 3) that was compared to three other regimens (Arms 1,2, and 4) in which central nervous system (CNS) prophylaxis was initiated after complete marrow remission (CR) was attained. The CR rate for Arm 3 was only 83% as compared to 91-92% for other Arms.…”

CNS prophylaxis in acute lymphoblastic leukemia. Comparison of two methods a southwest oncology group study

“…The details of these regimens have been previously reported. 6 Briefly, systemic therapy was as follows. Complete remission was achieved with either vincristine plus prednisone or cyclophosphamide + asparaginase + vincristine + prednisone.…”

Childhood Acute Lymphocytic Leukemia

“…Vincristine, prednisone, and L-asparaginase are common to most reg imens, producing an 85 to 93 percent complete remission rate. 2,6,8,48,49 Add ing other agents, such as daunorubicin and cyclophosphamide, has not im proved the remission rate50 and may even be detrimental. 49 If a child fails to enter remission, continuing vincristine and prednisone and adding doxorubicin or daunomycin are standard approaches.…”

“…2,6,8,48,49 Add ing other agents, such as daunorubicin and cyclophosphamide, has not im proved the remission rate50 and may even be detrimental. 49 If a child fails to enter remission, continuing vincristine and prednisone and adding doxorubicin or daunomycin are standard approaches. Recently, the combination of cytosine arabinoside and VM-26 was reported as effective for those in whom standard therapy fails to induce remission.…”