Background:
Timed sequential chemotherapy and high-dose cytarabine (cytosine arabinoside, ara-c; hdac) are both effective treatments for acute myeloid leukemia (aml). we review our institutional experience with timed sequential induction chemotherapy consisting of daunorubicin/ara-c/-thioguanine (dat) or idarubicin/ara-c/-thioguanine (iat) followed on day 14 by hdac regardless of the degree of marrow aplasia for children with newly diagnosed aml.
Procedure:
Children presenting with newly diagnosed aml were treated with induction chemotherapy consisting of idarubicin (12 mg/m/day on days 1-3 or daunorubicin at 45 mg/m(2)/day for the first five patients), ara-c (100 mg/m(2)/day by continuous infusion on days 1-7), and thioguanine (100 mg/m(2)/day on days 1-7). hdac (1 g/m(2)/dose every 12 hr for 10 doses) was administered beginning on day 14, regardless of the results of bone marrow examination.
Results:
Thirteen children received timed sequential hdac. only one child received hdac later than day 18. eleven of the children achieved a complete remission. all patients experienced grade 4 hematologic toxicity, and all had fever as well. there were 11 children with documented infections. ten had grade 3 or 4 gi toxicity. one patient died of sepsis.
Conclusions:
Hdac administered as a part of timed sequential therapy yields an excellent remission induction rate with manageable toxicity.