title: Experience with 2-chlorodeoxyadenosine in previously untreated children with newly diagnosed acute myeloid leukemia and myelodysplastic diseases.
abstract: OBJECTIVE
  To develop more effective chemotherapy regimens for childhood acute myelogenous leukemia (AML).
  
  
  METHODS
  Between June 1991 and December 1996, we administered the nucleoside analog 2-chlorodeoxyadenosine (2-CDA) to 73 children with primary AML and 20 children with secondary AML or myelodysplastic syndrome (MDS). Patients received one or two 5-day courses of 2-CDA (8.9 mg/m(2)/d) given by continuous infusion. All patients then received one to three courses of daunomycin, cytarabine, and etoposide (DAV) remission induction therapy.
  
  
  RESULTS
  Seventy-two patients with primary AML were assessable for response. Their rate of complete remission (CR) was 24% after one course of 2-CDA, 40% after two courses of 2-CDA, and 78% after DAV therapy. Of the 57 patients who entered CR, 11 subsequently underwent allogeneic bone marrow transplantation (BMT), and 40 underwent autologous BMT. Twenty-nine patients remain in continuous CR after BMT. Two patients remain in CR after chemotherapy only. The 5-year event-free survival (EFS) estimate was 40% (SE = 0.080%). Patients with French-American-British (FAB) M5 AML had a higher rate of CR after treatment with 2-CDA (45% after one course and 70.6% after two courses) than did others (P =.002). In contrast, no patient with FAB M7 AML (n = 10) entered CR after treatment with 2-CDA. Similarly, no patient with primary MDS (n = 6) responded to 2-CDA. Seven patients with secondary AML or MDS (n = 14) had a partial response to one course of 2-CDA.
  
  
  CONCLUSIONS
  This agent was well tolerated, and its toxicity was acceptable. Future trials should examine the effectiveness of 2-CDA given in combination with other agents effective against AML.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA. rakrance@bcm.tmc.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Krance
authors.forename: C A
authors.initials: CA
authors.lastname: Hurwitz
authors.forename: D R
authors.initials: DR
authors.lastname: Head
authors.forename: S C
authors.initials: SC
authors.lastname: Raimondi
authors.forename: F G
authors.initials: FG
authors.lastname: Behm
authors.forename: K R
authors.initials: KR
authors.lastname: Crews
authors.forename: D K
authors.initials: DK
authors.lastname: Srivastava
authors.forename: H
authors.initials: H
authors.lastname: Mahmoud
authors.forename: W M
authors.initials: WM
authors.lastname: Roberts
authors.forename: X
authors.initials: X
authors.lastname: Tong
authors.forename: R L
authors.initials: RL
authors.lastname: Blakley
authors.forename: R C
authors.initials: RC
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D017338:Cladribine / Q000008:administration & dosage / Q000494:pharmacology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D017338:Cladribine