title: Rescue therapy combining intermediate-dose cytarabine with amsacrine and etoposide in relapsed adult acute lymphoblastic leukemia.
abstract: In all, 625 patients with acute lymphoblastic leukemia (ALL) entered the Leucémie Aiguë Lymphoblastique de l'Adulte-94 trial from June 1994 to June 1999, and received a 4-week induction therapy followed either by chemotherapy alone or stem cell transplantation (SCT). In a clinical phase II study, 40 patients with standard- or high-risk ALL - except Philadelphia chromosome-positive ALL -, relapsing at least 3 months after the beginning of therapy and who did not receive any SCT, received a rescue protocol combining amsacrine 120 mg/m(2)/day, days 1-3, cytarabine 1 g/m(2)/12 h, days 1-5, and etoposide 100 mg/m(2)/day, days 1-5. All relapses occurred 'on therapy'. In all, 16 patients (40%) achieved a second complete remission. The median time to neutrophil recovery >0.5 x 10(9)/l was 27 days. The median time to platelet recovery >50 x 10(9)/l was 28 days. Extra-hematologic toxicity was mild (only one toxic death from severe infection). The median overall survival was 5.4 months. The median disease-free survival (DFS) was 3.2 months with a 3-year DFS of 12%. Unfavorable prognostic factors for complete remission achievement were: high-risk ALL at diagnosis (P=0.03), and white blood cell count at relapse >or=30 x 10(9)/l (P=0.02). No relationship was found between survival and any characteristics of the disease. Four patients underwent allogeneic SCT (two phenoidentical and two genoidentical) and three patients received autologous SCT. This treatment combining amsacrine, cytarabine, and etoposide was therefore effective and well tolerated in 'on-therapy'-relapsed ALL. However, the median DFS was short requiring the rapid completion of effective intensive postremission therapy.
authors.affiliation: Centre Hospitalier-Universitaire, Caen, France. reman-o@chu-caen.fr
authors.forename: Oumedaly
authors.initials: O
authors.lastname: Reman
authors.forename: Agnes
authors.initials: A
authors.lastname: Buzyn
authors.forename: Veronique
authors.initials: V
authors.lastname: Lhéritier
authors.forename: Francoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kuentz
authors.forename: Aspasia
authors.initials: A
authors.lastname: Stamatoullas
authors.forename: Andre
authors.initials: A
authors.lastname: Delannoy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Micléa
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Vernant
authors.forename: Claude
authors.initials: C
authors.lastname: Gardin
authors.forename: Maurice
authors.initials: M
authors.lastname: Hacini
authors.forename: Michel
authors.initials: M
authors.lastname: Georges
authors.forename: Denis
authors.initials: D
authors.lastname: Fière
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000677:Amsacrine / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D000677:Amsacrine; D003561:Cytarabine; D005047:Etoposide