Refractory leukemia treated with cytosine arabinoside and cyclophosphamide

Ansari, Behnaz; Thompson, E. N.

doi:10.1002/1097-0142(197308)32:2<294::aid-cncr2820320203>3.0.co;2-x

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…There is limited experience with the conibination of cyclophosphamide and ara-C: in two series of children treated with this combination. a complete remission was achieved in 4 of 7 (2 previously untreated) and 2 of 3 patients (both previously treated with vincristine and prednisone), respectively (29,30). A third series, including also adult patients, reported 9 CR's among 29 patients with relapsed AML(most previously treated with a non-ara-C containing regimen -POMP-)(3 I).…”

Section: Discussionmentioning

confidence: 99%

Cyclophosphamide, Ara-C and Topotecan (CAT) for Patients With Refractory or Relapsed Acute Leukemia

Cortes

Estey

Beran

et al. 2000

Leukemia & Lymphoma

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Topotecan is a topoisomerase I inhibitor with significant activity in patients with myelodysplastic syndrome and chronic myelomonocytic leukemia. Pre-clinical data suggest a synergistic activity with DNA damaging agents such as cyclophosphamide, where topotecan might prevent the repair of cyclophosphamide-induced DNA damage. We thus designed a combination including cyclophosphamide 500 mg/m2 every 12 hours given on days 1 to 3; topotecan 1.25 mg/m2/day by continuous infusion on days 2 to 6, and cytosine arabinoside (ara-C) 2 g/m2 over 4 hours daily for 5 days on days 2 to 6 (CAT). Sixty six (63 evaluable) patients were treated. Fifty two patients had refractory (n=12) or relapsed (n=40) acute myelogenous leukemia (AML), and eleven had acute lymphocytic leukemia (ALL) (refractory n=3, relapsed n=8); their median age was 57 years (range, 18 to 79 years). Eleven patients (17%) achieved a complete remission (CR), and two patients (3%) had a hematologic improvement (HI; met all criteria for CR except for platelets < 100x10(9)/L), for an overall response rate of 20%. Responses occurred in 12 of 52 AML patients (23%), including 10 CR (19%) and 2 HI (4%), and in 1 of 11 patients with ALL (9%). Myelosuppression was universal; there were 23 episodes of pneumonia or sepsis and 18 episodes of fever of unknown origin complicating 74 courses of CAT. Non-hematologic toxicity was mostly gastrointestinal, including nausea, vomiting, diarrhea and mucositis, but was severe in only 8%. In summary, the CAT regimen is well tolerated and has significant anti-leukemia activity which warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Cyclophosphamide, Ara-C and Topotecan (CAT) for Patients With Refractory or Relapsed Acute Leukemia

Cortes

Estey

Beran

et al. 2000

Leukemia & Lymphoma

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“…'l The combination of CA and CYT has had very limited clinical trials in children with leukemia. 1,8 Our experience in treating children with AGL, using both regimens, is herein reported.…”

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confidence: 99%

Improved survival in young children with acute granulocytic leukemia treated with combination therapy using cyclophosphamide, oncovin, cytosine arabinoside, and prednisone

Madanat¹,

Sullivan²

1979

Cancer

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Seven of 17 children (41%) under 5 years of age with acute granulocytic leukemia (AGL) treated with either cytosine arabinoside-cytoxan (CA-CYT) or Mini-COAP (CA-CYT with vincristine sulfate [VCR] and prednisone) have been in continuous complete remission 4 years or more. CA and CYT were each given in the dosage of 120 mg/m2 intravenously, daily in 3 divided doses, for 4 days. Induction consisted of two courses given at intervals of 2 weeks; during maintenance the courses were repeated at intervals of 4 weeks. In the Mini-COAP regimen, standard 28-day VCR-prednisone therapy was superimposed on CA-CYT induction and 4-day VCR-prednisone pulses were superimposed on CA-CYT maintenance. Transient moderate to severe myelosuppression was frequent; other manifestations of toxicity were mild. Administration of drugs at home was feasible in many instances. Mini-COAP was proved to be an effective therapeutic regimen for young children with AGL and should be considered as initial therapy.Cancer 44 Accepted for publication September 29, 1978. out affecting the duration of rernission.'l The combination of CA and CYT has had very limited clinical trials in children with leukemia. 1, 8 Our experience in treating children with AGL, using both regimens, is herein reported. MATERIALS AND METHODSChildren under 16 years of age with AGL were eligible for study. Prior therapy with VCR and prednisone in combination, or CA and CYT given alone, did not disqualify patients from the study. Treatment PlansAs shown in Table 1, VCR was given in a dose of 2 mg/m2 (maximum dose 2 mg) intravenously, weekly for five doses in the induction phase and on day 1 of each pulse treatment in the maintenance phase.In the induction phase, prednisone was given in a dose of 60 mg/m2/day (maximum dose 60 rng) by mouth in four divided doses for 4 weeks, then tapered over the fifth week. In maintenance, prednisone was given in a pulse course, 120 mg/m2/day p.0. in four divided doses for 4 days, then discontinued.

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“…Partial remission indicated some symptomatic and haematological improvement, and failure implied no change or obvious deterioration (Ansari and Thompson, 1973 November, 1970. The initial white blood counts ranged from 19,600/mm3 to 9100/mm3 with 56% myeloblasts.…”

Section: Introductionmentioning

confidence: 99%

Methoxy-9-ellipticine lactate in refractory acute myeloid leukaemia

Ansari

Thompson

1975

Postgraduate Medical Journal

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SummaryTwo cases of refractory acute myeloid leukaemia were treated with methoxy-9-ellipticine lactate alone and in combination with other chemotherapeutic agents. In the first patient a successful complete second and third remission was achieved lasting 2 and 3 months respectively. However, a partial remission was obtained in the second patient as treatment with methoxy-9-ellipticine was only started in the terminal phase of the illness. In view of the resistance of this form of leukaemia to present chemotherapeutic drugs both initally and at the time of relapse, the response of these two cases to methoxy-9-ellipticine is worth reporting. IntroductionMethoxy-9-ellipticine has been shown to be effective in acute myeloid leukaemia (AML) although ineffective in acute lymphatic leukaemia and Hodgkin's disease (Mathe et al., 1970). It is a potent inhibitor of DNA synthesis, but also affects RNA and protein synthesis to a lesser extent (GarciaGiralt and Macieira-Coelho, 1970). Initial remission induction is difficult in AML with at best 60% success rate using multiple drugs (Crowther et al., 1970), however, second remissions are rare. We have recently used methoxy-9-ellipticine in two children with AML and were able to induce a second remission in both. The effect in one was striking and we suggest that if this drug had been used earlier in the other patient a longer remission might have resulted. Both patients had proved refractory to other drug combinations.The criteria for a successful complete remission were the resolution of symptoms and organomegaly with no blasts in the peripheral blood and less than 5 % in the bone marrow, a neutrophil count over 1500/mm3 and the platelet count greater than 100,000/mm3. Partial remission indicated some symptomatic and haematological improvement, and failure implied no change or obvious deterioration (Ansari and Thompson, 1973).

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Refractory leukemia treated with cytosine arabinoside and cyclophosphamide

Cited by 4 publications

References 8 publications

Cyclophosphamide, Ara-C and Topotecan (CAT) for Patients With Refractory or Relapsed Acute Leukemia

Cyclophosphamide, Ara-C and Topotecan (CAT) for Patients With Refractory or Relapsed Acute Leukemia

Improved survival in young children with acute granulocytic leukemia treated with combination therapy using cyclophosphamide, oncovin, cytosine arabinoside, and prednisone

Methoxy-9-ellipticine lactate in refractory acute myeloid leukaemia

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