title: Sequential administration of methotrexate and asparaginase in relapsed or refractory pediatric acute myeloid leukemia.
abstract: BACKGROUND
  The efficacy of combination chemotherapy with methotrexate (MTX) and asparaginase is not well known in relapsed and refractory acute leukemia after contemporary therapy.
  
  
  METHODS
  A retrospective study of pediatric patients with relapsed or refractory acute myeloid leukemia (AML) who received MTX and asparaginase as a salvage therapy at St. Jude Children Research Hospital was performed. MTX was given intravenously followed by a dose of asparaginase intramuscularly or intravenously 24 hours later. The chemotherapy cycle was repeated every 7-10 days. Response, survival, and toxicities were evaluated.
  
  
  RESULTS
  Fifteen patients, median age 10.5 years (range, 1.1-18.5 years), were treated. Median number of previous therapeutic regimens was three (range, 1-4). Six patients responded to treatment (three had morphologic complete remission with incomplete blood count recovery, two had partial remission, and one had stable disease for 16 months), and four are still alive. Three of six responders had monoblastic leukemia, and also developed tumor lysis syndrome. The 1- and 2-year overall survival rates are 35.6% and 17.8%, respectively. The most common adverse event was transient elevation of transaminases (nine patients). Two patients developed pancreatitis. Episodes of febrile neutropenia were rare (two patients), and most courses (75 out of 93 total courses) were given in an outpatient setting.
  
  
  CONCLUSIONS
  Combination chemotherapy with MTX and asparaginase appears to be an effective salvage therapy and well tolerated in patients with relapsed or refractory childhood AML, even in those heavily pretreated with contemporary frontline or salvage therapy.
authors: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
authors: Jassada
authors: J
authors: Buaboonnam
authors: Xueyuan
authors: X
authors: Cao
authors: Jennifer L
authors: JL
authors: Pauley
authors: Ching-Hon
authors: CH
authors: Pui
authors: Raul C
authors: RC
authors: Ribeiro
authors: Jeffrey E
authors: JE
authors: Rubnitz
authors: Hiroto
authors: H
authors: Inaba
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001215:Asparaginase / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods
chemical_list: D001215:Asparaginase; D008727:Methotrexate