title: Sequential induction chemotherapy with vincristine, daunorubicin, cyclophosphamide, and prednisone in adult acute lymphoblastic leukemia.
abstract: Sequential chemotherapy with vincristine, daunorubicin, cyclophosphamide, and prednisone doses was administered to 57 adult patients with acute lymphoblastic leukemia (ALL). Complete remission (CR) was achieved in 51 (89%, 95% confidence intervals, [CI] 78-96%). Among patients achieving CR, 62% were in CR after one sequence of chemotherapy, 23% after two sequences, and 5% after three sequences. Six patients (11%) had resistant disease. All patients experienced profound myelosuppression. Median time to recovery of neutrophils > 0.5 x 10(9)/1 was 22 days (range: 5-89 days), and of platelets > 100 x 10(9)/1 21 days (range: 0-45 days). Nonhematologic WHO grade 3 or more side effects consisted predominantly of hyperbilirubinemia (7%), mucositis (5%), nausea and vomiting (2%), and cutaneous toxicity (1%). Severe infectious complications occurred in only 14% of cases. One patient (2%, 95% CI 0-9%) died of therapy-related toxicity while in early CR. We concluded that sequential use of prednisone seemed at least as effective as continuous administration at the expense of a few adverse side effects.
authors.affiliation: Department of Hematology, Hôpital Edouard Herriot, Lyon, France.
authors.forename: X
authors.initials: X
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Danaïla
authors.forename: Q K
authors.initials: QK
authors.lastname: Bach
authors.forename: P
authors.initials: P
authors.lastname: Dufour
authors.forename: B
authors.initials: B
authors.lastname: Christian
authors.forename: B
authors.initials: B
authors.lastname: Corront
authors.forename: A
authors.initials: A
authors.lastname: Bosly
authors.forename: Y
authors.initials: Y
authors.lastname: Bastion
authors.forename: N
authors.initials: N
authors.lastname: Gratecos
authors.forename: R
authors.initials: R
authors.lastname: Leblay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D016001:Confidence Intervals; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010865:Pilot Projects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards; D012074:Remission Induction; D016879:Salvage Therapy; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000592:standards
chemical_list: D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone; D003630:Daunorubicin