title: Unexpected high incidence of severe toxicities associated with alpha interferon, low-dose cytosine arabinoside and all-trans retinoic acid in patients with chronic myelogenous leukemia.
abstract: Preclinical data have shown that all-trans retinoic acid (ATRA) with interferon-alpha (IFN-alpha) can exert significant suppressive effects on Philadelphia-chromosome (Ph)-positive cells. The aim of this study combining IFN-alpha, low-dose cytosine arabinoside (ara-C) and ATRA was to increase the proportion of patients achieving a major cytogenetic response, in comparison with a group of 140 patients previously treated with IFN-alpha plus low-dose ara-C. Forty three patients with Ph-positive CML in early chronic phase were treated with IFN-alpha 5 MU/m2 s.c. daily, low-dose ara-C 10 mg s.c. daily and ATRA 45 mg/m2 orally daily, for 7 consecutive days every other week. Overall, 76% of patients achieved a complete hematologic response (CHR). A cytogenetic response was in observed 59% (major in 38% and complete in 17%). Compared with patients treated with IFN-alpha and low-dose ara-C, those receiving additional ATRA had a lower CHR rate (p. 014), but other response rates were similar. Severe toxicities were common with the triple regimen (64%), mostly related to ATRA therapy. Two patients experienced pseudotumor cerebri; two patients had leukocytosis during the week on ATRA treatment, decreasing during the week off (one suffered a severe asthma-like reaction followed by pulmonary edema, resembling ATRA syndrome). Six patients had other unusual side-effects: aseptic necrosis of the hip (1 patient), ataxic syndrome (1 patient), paranoid syndrome (2 patients), syncopal episodes (1 patient), pure red cell aplasia (1 patient). In conclusion the results of IFN-alpha and low-dose ara-C combined with ATRA in patients with early CML-chronic phase were disappointing, due to excessive toxicity. Whether different ATRA dose schedules may result in fewer side-effects and improve hematologic and cytogenetic response remains to be determined.
authors.affiliation: Department of Leukemia, MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sacchi
authors.forename: H M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: E J
authors.initials: EJ
authors.lastname: Freireich
authors.forename: S
authors.initials: S
authors.lastname: O'Brien
authors.forename: J
authors.initials: J
authors.lastname: Cortes
authors.forename: M B
authors.initials: MB
authors.lastname: Rios
authors.forename: S
authors.initials: S
authors.lastname: Kornblau
authors.forename: F J
authors.initials: FJ
authors.lastname: Giles
authors.forename: C
authors.initials: C
authors.lastname: Koller
authors.forename: J
authors.initials: J
authors.lastname: Gajewski
authors.forename: M
authors.initials: M
authors.lastname: Talpaz
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001259:Ataxia / Q000139:chemically induced; D003131:Combined Modality Therapy / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D007964:Leukocytosis / Q000139:chemically induced*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010259:Paranoid Disorders / Q000139:chemically induced; D010865:Pilot Projects; D011559:Pseudotumor Cerebri / Q000139:chemically induced*; D011654:Pulmonary Edema / Q000139:chemically induced; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced; D012074:Remission Induction; D016019:Survival Analysis; D013575:Syncope / Q000139:chemically induced; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000964:Antimetabolites, Antineoplastic; D007155:Immunologic Factors; D016898:Interferon-alpha; D003561:Cytarabine; D014212:Tretinoin