title: Intensive remission induction therapy for chronic myeloid leukemia in blast phase with a goal of post-remission bone marrow transplant--a pilot study.
abstract: An intensive protocol utilizing mitoxantrone, high-dose cytarabine, vincristine, etoposide and methylprednisolone as induction therapy for chronic myeloid leukemia in blast transformation is described. Fourteen patients were treated, with a remission/second chronic phase achieved in 64%. None of the 3 patients older than 50 yr responded. Complete hematological responses were seen in 9 of the 11 younger patients, 4 of whom also became BCR-ABL negative by Southern Blot analysis. Four patients went on to allogeneic bone marrow transplant. Median remission durations were 4.5 (1-5) and 8.5 (5-16) months in the non-transplanted and transplanted cohorts, respectively. Median survival is 1.5 (0.5-3), 9.5 (7-14) and 17 (14-61+) months in the non-responding, responding non-transplanted and transplanted cohorts, respectively. Toxicity, particularly gastrointestinal, was significant. This represents an aggressive protocol that should be reserved for patients who are potential transplant candidates.
authors.affiliation: Department of Medicine, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, Canada.
authors.forename: J H
authors.initials: JH
authors.lastname: Lipton
authors.forename: H A
authors.initials: HA
authors.lastname: Messner
authors.forename: J E
authors.initials: JE
authors.lastname: Curtis
authors.forename: H L
authors.initials: HL
authors.lastname: Atkins
authors.forename: M D
authors.initials: MD
authors.lastname: Minden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001752:Blast Crisis; D016026:Bone Marrow Transplantation; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000032:analysis; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D010865:Pilot Projects; D012074:Remission Induction; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D008942:Mitoxantrone; D016044:Fusion Proteins, bcr-abl; D008775:Methylprednisolone