title: Treatment of the blastic phase of chronic myelogenous leukemia with mitoxantrone and high-dose cytosine arabinoside.
abstract: Twenty-seven patients in the blastic phase of chronic myelogenous leukemia received combination chemotherapy with mitoxantrone 5 mg/m2 intravenously daily for 5 days, and cytosine arabinoside 3 g/m2 intravenously over 2 hours every 12 hours for six doses. The patients' median age was 42 years (range, 19-61 years), and 26 of them had Philadelphia chromosome-positive disease. Overall, seven patients (26%) achieved complete remission, and one (4%) had a partial remission for an overall response rate of 30%. Eight patients died during remission induction, and 11 had resistant disease. The median survival was 14 weeks for the total population, and 24 weeks for patients achieving a complete remission. The nonmyelosuppressive toxicity of the combination was acceptable; serious neurologic and pulmonary toxicities were uncommon. Significant marrow hypoplasia was observed resulting in a high incidence of febrile episodes (85% of patients). The combination of mitoxantrone and high-dose cytosine arabinoside did not significantly improve overall prognosis. Since chemotherapy continues to produce disappointing results, other innovative approaches need to be explored.
authors.affiliation: Department of Hematology, M. D. Anderson Hospital and Tumor Institute, Houston, TX 77030.
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: R S
authors.initials: RS
authors.lastname: Walters
authors.forename: M J
authors.initials: MJ
authors.lastname: Keating
authors.forename: M
authors.initials: M
authors.lastname: Talpaz
authors.forename: B
authors.initials: B
authors.lastname: Andersson
authors.forename: M
authors.initials: M
authors.lastname: Beran
authors.forename: K B
authors.initials: KB
authors.lastname: McCredie
authors.forename: E J
authors.initials: EJ
authors.lastname: Freireich
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001752:Blast Crisis / Q000188:drug therapy*; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011379:Prognosis; D012074:Remission Induction
chemical_list: D003561:Cytarabine; D008942:Mitoxantrone