Etoposide in combination with intermediate dose cytosine arabinoside (ID ARA C) given with the intention of further myeloablative therapy for the treatment of refractory or recurrent hematological malignancy
✍ Scribed by Dr J. S. Whelan; C. L. Davis; A. Z. S. Rohatiner; M. Leahy; P. K. Maccallum; R. K. Gupta; J. Matthews; A. J. Norton; J. A. L. Amess; T. A. Lister
- Publisher
- John Wiley and Sons
- Year
- 1992
- Tongue
- English
- Weight
- 510 KB
- Volume
- 10
- Category
- Article
- ISSN
- 0278-0232
No coin nor oath required. For personal study only.
✦ Synopsis
Thirty-four patients with refractory or recurrent high grade non-Hodgkin's lymphoma (NHL) or acute leukemia were treated with a combination of etoposide, 100 mg/mZ daily, and ara C, 1 g/m2 twice daily, for 5 days (VPARAC). This therapy was given in the anticipation that remissions thus achieved would be 'consolidated' with myeloablative therapy supported by bonemarrow transplantation (BMT). Thecomplete remission rate(CR)inpatientswithNHLwas3/18(17percent)withpartialresponses(PR)seen inafurtherfourpatients, giving an overall response rate of 39 per cent. Four patients (three in CR, one in PR) proceeded to the planned consolidation treatment. Complete remissionwasachieved in2/8 (25 percent)patientswithacutemyelogenous leukemia (AML) and in 2/8 patients with acute lymphoblastic leukemia (ALL). Three of these patients subsequently had myeloablative consolidation therapy with BMT. There were four treatment-related deaths (NHL, two; AML, one; ALL, one). In poor risk patients with high grade NHL and acute leukemia, VPARAC is an effective remission induction programme in 21 per cent of patients. Seven of the original 34 patients received the intended 'curative' therapy, of whom only four are alive and well 1 year later.
KEY WORDS Ara-C Etoposide Leukemias non-Hodgkin's lymphoma INTRODUCTION
A proportion of adults with acute leukemia and advanced high grade lymphoma may be cured with currently available 'first line' therapy.'-'* A further proportion may respond initially but ultimately the therapy is unsuccessful, as manifest either by failure to achieve complete remission, or by recurrence. It is possible that the dismal outlook for this group may be improved by the judicious use of myeloablative therapy supported by bone marrow Since this has repeatedly been shown to be most effective in those with disease sensitive to chemotherapy and in those with minimal or undetectable disease at the time of ablative treatment,I3-l6 a satisfactory 'salvage' therapy, to be given at the point of initial failure, needs to be identified.
Cytosine arabinoside has been established as one of the most effective agents in the treatment of acute leukemia, both alone and in combination with other drugs.''-l9 Activity has also been