Therapy of lymphoid and undifferentiated chronic myelogenous leukemia in blast crisis with continuous vincristine and adriamycin infusions plus high-dose decadron

Abstract

Thirty patients with Philadelphia chromosome-positive lymphoid (20 patients) or undifferentiated (ten patients) chronic myelogenous leukemia in blast crisis were treated with 0.4 mg of vincristine by continuous intravenous infusion (CIV) daily for 4 days; (doxorubicin) 12 mg/m2 of Adriamycin (Adria Laboratories, Columbus, OH) by continuous intravenous infusion daily for 4 days; and 40 mg of decadron daily on days 1 through 4, 9 through 12, and 17 through 20 (VAD). Course 2 was given starting on day 24 with the addition of cyclophosphamide 1 g/22. Overall nine patients achieved complete remission (30%) and three attained a partial remission (10%), for an overall response rate of 40%. Four patients expired during induction whereas 14 had resistant disease. Response rate was significantly higher for patients with lymphoid compared to undifferentiated morphology (55% versus 10%; P = 0.05). In lymphoid blast crisis, Calla-positive disease was associated with a higher response rate compared to Calla-negative disease (75% versus 25%; P = 0.08). Eleven patients developed infections, and seven had fever without documented infections. The median overall survival was 29 weeks. Median survival was 43 weeks for patients achieving complete remission and 20 weeks for those with resistant disease. Remission duration was 39 weeks. After primary and salvage therapy, nine patients are alive, six of them in continuous remission for 19+ to 112+ weeks. The authors conclude that VAD chemotherapy is an effective regimen with acceptable toxicity in patients with lymphoid blast crisis especially those with Calla-positive disease. Alternate induction regimens for undifferentiated disease and for maintenance therapy are currently being investigated.

‘Lymphoid’ blast crisis of chronic myeloid leukaemia is associated with distinct clinicohaematological features

“…The better prognosis of ‘lymphoid’ BC patients observed in the present study is a well‐known fact, which has been linked to their high response rates to acute lymphoblastic leukaemia‐like chemotherapy regimens, especially those incorporating vincristine and prednisone ( Marks et al , 1978 ; Janossy et al , 1979 ; Walters et al , 1987 ; Derderian et al , 1993 ). However, although the survival of such patients is almost 3 times that of other BC patients, it should be kept in mind that in these cases the benefit derived from a favourable response was brief.…”

Improved survival in chronic myeloid leukemia since the introduction of imatinib therapy: a single-institution historical experience

“…The diagnostic criteria for CML phases were as described previously. 5,6 The characteristics of patients are detailed in Table 1.…”

Chronic myelogenous leukemia in nonlymphoid blastic phase

“…Objective responses are seen in ≤20% of patients, and the median survival is 2–5 months. Several chemotherapy regimens have been investigated in patients with CML‐BP 7–15, 19–39. Comparisons are difficult given the marked heterogeneity of studies in terms of different treatment regimens and varying criteria for blastic phase and for response.…”