Background:
The majority of adult patients who are treated for lymphoblastic disease will either develop recurrent disease or will be refractory to their initial therapy. one option for patients with recurrent/refractory disease is to administer a reinduction regimen that employs a dose-intense combination of anthracycline and cytarabine. these salvage regimens are relatively distinct from the traditional vincristine/prednisone-based programs that are used typically as primary induction therapy. the authors studied a regimen that contained high-dose cytarabine and a single high dose of idarubicin as salvage induction therapy for patients with recurrent or refractory lymphoblastic disease.
Methods:
Twenty-nine previously treated adult patients with recurrent or refractory acute lymphoblastic leukemia were treated with a new intensive regimen. eight patients had primary refractory disease. twenty-one patients had recurrent disease, and 16 of these patients developed recurrent disease while they were still receiving their primary therapy. the treatment regimen consisted of cytarabine 3.0 g/m(2) by 3-hour infusion daily for 5 days and idarubicin 40 mg/m(2) given as a single dose on day 3. filgrastim (granulocyte-colony stimulating factor) 5 microg/kg administered subcutaneously every 12 hours was started on day 7 and was continued until the absolute neutrophil count was > 5000/microl. response was assessed using standard criteria.
Results:
There were 11 complete responses (38%; 95% confidence interval, 20-56%). four patients subsequently underwent allogeneic bone marrow transplantation. moderate but acceptable toxicity was observed given the severely myelosuppressive nature of the regimen. there was only one treatment-related death (3%). two patients, both with significant prior exposure to anthracyclines, suffered reductions in left ventricular function to the 20-30% range during episodes of severe systemic infection. after recovery from infection, the ejection fraction in one patient improved to 50%.
Conclusions:
The authors conclude that this regimen has moderate activity and a relatively low incidence of mortality for this high-risk group of patients. this regimen may be most suitable for patients who can undergo potentially curative allogeneic bone marrow transplantation if they achieve a complete response.