title: 2-Chlorodeoxyadenosine with or without daunorubicin in relapsed or refractory acute myeloid leukemia.
abstract: 2-Chlorodeoxyadenosine (2-CdA) is a purine analogue which has proved to be active in acute myeloid leukemia (AML), especially in children. In adults, results yielded by 2-CdA alone or with ara-C were less encouraging. Here we report on the efficacy of 2-CdA with or without daunorubicin (DNR) in 19 relapsing or refractory adult AML patients, with a median age of 57 years. 2-CdA was administered as a continuous infusion to all patients at a dose of 0.1 mg/kg per day for 7 days. For 14 patients, DNR was added at a dose of 50 mg/m2 per day on days 5, 6, and 7. Antileukemic activity was observed in all the patients, but no single complete remission was achieved. One patient had a long-lasting partial response (response rate=5%). The remaining patients died of progressive AML (n=7), uncontrollable infection with persistent disease (n=10), and cerebral hemorrhage (n=1). Median survival from start of 2-CdA therapy was 56 days. Long-lasting neutropenia and transfusion-dependent thrombopenia were encountered in all 16 evaluable patients. Grade 4 hepatic toxicity occurred in one patient. Other side effects included nausea in six, mucositis in three, and mental disturbances in three patients. Compared with 2-CdA alone, the addition of DNR to 2-CdA changed neither the response rate nor the toxicities. In conclusion, our data do not support the use of 2-CdA +/- DNR for relapsing or refractory adult AML patients, at least as used in the present regimen.
authors.affiliation: Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Van Den Neste
authors.forename: P
authors.initials: P
authors.lastname: Martiat
authors.forename: P
authors.initials: P
authors.lastname: Mineur
authors.forename: A
authors.initials: A
authors.lastname: Delannoy
authors.forename: C
authors.initials: C
authors.lastname: Doyen
authors.forename: A
authors.initials: A
authors.lastname: Zenebergh
authors.forename: J L
authors.initials: JL
authors.lastname: Michaux
authors.forename: A
authors.initials: A
authors.lastname: Ferrant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017338:Cladribine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003630:Daunorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D017338:Cladribine; D003630:Daunorubicin