Treatment of Relapsed or Refractory Acute Leukemia: Comparison of Two Different Regimens

Marit, Gérald; Cony, P.; Duclos, F; Puntous, M.; Broustet, A

doi:10.1007/978-3-642-74643-7_112

Cited by 5 publications

(1 citation statement)

References 6 publications

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“…The median duration of CR was 3.6 months in five studies. The combination of HDAC with mitoxantrone, amsacrine, idarubicin, or vincristine plus steroids yielded a 60% CR rate among 442 patients and a 12% treatment-related death rate [8, [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The median duration of CR of 3.4 months is similar to that achieved The most extensive experience in salvage chemotherapy for adult ALL is with vincristine, prednisone, and anthracycline-type agents.…”

Section: Resultsmentioning

confidence: 99%

Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

Welborn

1994

American J Hematol

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The clinical outlook for adults with acute lymphoblastic leukemia (ALL) has improved with the use of intensive chemotherapy. Complete remissions (CR) are achieved in 80% of adults but the majority relapse on maintenance chemotherapy and a few exhibit primary resistance to induction therapy. This report compares the various salvage treatments and provides guidance in selecting a regimen with the optimum clinical outcome. Regimens using high-dose ara-C (HDAC) in combination with mitoxantrone, amsacrine, or idarubicin are superior to HDAC alone or with L-asparaginase. The sequential administration of methotrexate and L-asparaginase is equally effective. The duration of second CR is short for all chemotherapeutic regimens.

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Section: Resultsmentioning

confidence: 99%

Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

Welborn

1994

American J Hematol

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Rescue therapy combining intermediate-dose cytarabine with amsacrine and etoposide in relapsed adult acute lymphoblastic leukemia

Buzyn¹,

Lhéritier²,

Huguet³

et al. 2004

Hematol J

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In all, 625 patients with acute lymphoblastic leukemia (ALL) entered the Leucémie Aiguë Lymphoblastique de l'Adulte-94 trial from June 1994 to June 1999, and received a 4-week induction therapy followed either by chemotherapy alone or stem cell transplantation (SCT). In a clinical phase II study, 40 patients with standard- or high-risk ALL - except Philadelphia chromosome-positive ALL -, relapsing at least 3 months after the beginning of therapy and who did not receive any SCT, received a rescue protocol combining amsacrine 120 mg/m(2)/day, days 1-3, cytarabine 1 g/m(2)/12 h, days 1-5, and etoposide 100 mg/m(2)/day, days 1-5. All relapses occurred 'on therapy'. In all, 16 patients (40%) achieved a second complete remission. The median time to neutrophil recovery >0.5 x 10(9)/l was 27 days. The median time to platelet recovery >50 x 10(9)/l was 28 days. Extra-hematologic toxicity was mild (only one toxic death from severe infection). The median overall survival was 5.4 months. The median disease-free survival (DFS) was 3.2 months with a 3-year DFS of 12%. Unfavorable prognostic factors for complete remission achievement were: high-risk ALL at diagnosis (P=0.03), and white blood cell count at relapse >or=30 x 10(9)/l (P=0.02). No relationship was found between survival and any characteristics of the disease. Four patients underwent allogeneic SCT (two phenoidentical and two genoidentical) and three patients received autologous SCT. This treatment combining amsacrine, cytarabine, and etoposide was therefore effective and well tolerated in 'on-therapy'-relapsed ALL. However, the median DFS was short requiring the rapid completion of effective intensive postremission therapy.

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A prospective study comparing vancomycin and teicoplanin as second‐line empiric therapy for infection in neutropenic patients

Cony‐Makhoul¹,

Brossard²,

Pellegrin³

et al. 1990

Br J Haematol

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In recent years, the most common cause of infection in neutropenic patients has shifted from Gram-negative to Gram-positive bacteria. To compare the efficacy and toxicity of teicoplanin and vancomycin in neutropenic patients, we conducted a prospective study of 151 adult leukaemic patients hospitalized for intensive chemotherapy. After chemotherapy, the median duration of granulocytopenia (less than 500/mm3) was 25 d (range 13-49). When the patients became febrile, they received ceftazidime (CTZ) alone (2 g every 12 h, intravenously). If fever persisted more than 48-72 h after administration of CTZ, the patients were randomly assigned to receive CTZ combined with either vancomycin (vanco) (30 mg/kg/d) or teicoplanin (teico) (6 mg/kg every 12 h on day 1, then daily). When fever persisted further, an aminoglycoside antibiotic and/or amphotericin B were usually added to the previous combination. Of the 151 patients, 116 patients became febrile during the period of aplasia. Fifty-nine patients had persistent (or recurrent) fever despite administration of CTZ and received either vanco (n = 35) or teico (n = 24). Sixteen of these latter 59 patients had septicaemia (vanco n = 9; teico n = 7) due to Candida sp. (n = 2), Gram-negative (n = 2) or Gram-positive (n = 12) bacteria. The main characteristics of patients and infection were similar in both arms. The treatment was considered as a success (disappearance of fever within 48 h) in 21/35 patients of the vanco group (60%) compared to 13/24 patients of the teico group (54%; P not significant). The percentage of failures for infection due to Gram-positive bacteria was 2/11 for vanco versus 2/7 for teico (P not significant). Two patients in each group died from infection. The main cause of failure was retrospectively attributed to fungal pathogens. No major toxic effects were found in either group. These preliminary results do not show any difference between vanco and teico as second-line antibiotic therapy in leukaemic patients with severe and prolonged granulocytopenia.

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Treatment of Relapsed or Refractory Acute Leukemia: Comparison of Two Different Regimens

Cited by 5 publications

References 6 publications

Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

Impact of reinduction regimens for relapsed and refractory acute lymphoblastic leukemia in adults

Rescue therapy combining intermediate-dose cytarabine with amsacrine and etoposide in relapsed adult acute lymphoblastic leukemia

A prospective study comparing vancomycin and teicoplanin as second‐line empiric therapy for infection in neutropenic patients

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