title: Impact of high-dose cytosine arabinoside in poor-prognosis acute lymphoblastic leukemia: Cancer Institute experience, Chennai, India.
abstract: High-dose cytosine arabinoside (HD-AraC) has been used in relapsed and refractory cases of acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma (NHL). Sixty-two poor-prognosis ALL patients were treated with HD-AraC between 1983 and 1995 at the Cancer Institute, Chennai, India. Of them, 37 had experienced a relapse, 16 were partial responders (refractory) to the induction regimen, and 9 were high risk due to central nervous system or testicular involvement or total counts above 200,000/mm3 at presentation. Of the 37 patients with relapses, 22 (59.5%) achieved complete remission (CR) and 10 had no evidence of disease (NED); of the 16 refractory group patients, 10 achieved CR and 2 had NED; and of the 9 high-risk patients, 5 had NED at the end of the study. The 5-year event-free survival (EFS) values of relapsed, refractory and high-risk group categories were 21.7%, 12.5%, and 55.6%, with a mean duration of 41 months, 18 months, and 85 months, respectively. Total alopecia and grade IV myelosuppression were the predominant toxicities. HD-AraC is an effective drug in the treatment of relapsed and refractory acute leukemias and can overcome relative drug resistance in high concentrations.
authors.affiliation: Cancer Institute (WIA), Chennai, India.
authors.forename: T G
authors.initials: TG
authors.lastname: Sagar
authors.forename: S G
authors.initials: SG
authors.lastname: Ramanan
authors.forename: S
authors.initials: S
authors.lastname: Devarajan
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine