title: All-trans retinoic acid and low-dose cytosine arabinoside for the treatment of 'poor prognosis' acute myeloid leukemia.
abstract: Thirty-three patients with 'poor prognosis' acute myeloid leukemia, no longer suitable for aggressive chemotherapy, were treated with daily oral all-trans retinoic acid (45 mg/m2) daily and subcutaneous cytosine arabinoside (20 mg standard dose twice a day, day 1 to 10, every 4 weeks). Seventeen patients were males and 16 females, the median age was 67 (range 39-82 years). Eleven patients were at onset of disease, 15 were refractory to previous conventional therapies, three were in first relapse and three in second relapse and one patient had a secondary AML. Seventeen patients had a bone marrow blast infiltration < 50% and 16 > or = 50%. A total of 16 (48%) patients entered complete remission; the rate of complete remission increased to 88% in those patients (n = 17) with < 50% blast infiltration at the time of entering the study. Seventeen patients (52%) were resistant. The difference in response to therapy, according to bone marrow blast percentage (< or > or = 50%), was statistically significant (P < 0.001). Median duration of complete remission was 34.4 weeks (range 6.4-62.8). Mild to moderate hematologic toxicity was the most common side-effect. In conclusion all-trans retinoic acid and low-dose cytosine arabinoside appears to be an effective regimen for inducing complete remission in 'poor prognosis' acute myeloid leukemia and patients with < 50% bone marrow infiltration are likely to represent the ideal target to receive this combination therapy.
authors.affiliation: Cattedra di Ematologia, Osp S Eugenio, Università di Roma Tor Vergata, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Venditti
authors.forename: R
authors.initials: R
authors.lastname: Stasi
authors.forename: G
authors.initials: G
authors.lastname: Del Poeta
authors.forename: F
authors.initials: F
authors.lastname: Buccisano
authors.forename: G
authors.initials: G
authors.lastname: Aronica
authors.forename: A
authors.initials: A
authors.lastname: Bruno
authors.forename: F
authors.initials: F
authors.lastname: Pisani
authors.forename: T
authors.initials: T
authors.lastname: Caravita
authors.forename: M
authors.initials: M
authors.lastname: Masi
authors.forename: M
authors.initials: M
authors.lastname: Tribalto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D003561:Cytarabine; D014212:Tretinoin