High-dose cytosine arabinoside and L-asparaginase in refractory acute lymphoblastic leukemia: The Children's Cancer Group Experience

✍ Scribed by Harris, Richard E.; Sather, Harland N.; Feig, Stephen A.

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 42 KB
• Volume: 30
• Category: Article
• ISSN: 0098-1532
• DOI: 10.1002/(sici)1096-911x(199804)30:4<233::aid-mpo5>3.0.co;2-h

✦ Synopsis

Problem. Therapy of children with relapsed acute lymphoblastic leukemia (ALL) not achieving a second remission (CR2) after an initial reinduction attempt is problematic.

Methods. 52 children with ALL in first relapse received high-dose cytosine arabinoside and L-asparaginase (HDAraC/L-Asp) after failed attempts to achieve CR2. AraC was given at a dose of 3 gm/m 2 q12 h × 4 on days 0-1 and 7-8. L-asparaginase was given IM 6,000 IU/m 2 3 hours after the completion of each 2-day cycle of AraC.

Results. Of the 42 surviving to day 28, 22 (42% of all patients) achieved CR2. Ten died before day 28 (19%); four from leukemia and six from infections or toxicity (12% regimenrelated mortality). There were 17 bacterial infections (three fatal), 17 invasive fungal infec-tions (12 fatal), one fatal adenoviral infection, and one non-fatal Pneumocystis pneumonia. One patient was surviving when lost to followup at four months and one patient survives over 5 years after transplant. Sixteen of the 22 patients who entered CR2 subsequently relapsed, five died of non-leukemic causes, and one was lost to follow-up. The median duration of second remission was 3 months (range 0.7 to 19 months).

Conclusions. HDAraC/L-Asp rescue reinduction for relapsed childhood ALL achieves CR2 in ∼40% of patients who fail reinduction, but remissions are short for most patients and maintenance of CR2 remains unsatisfactory.