A combination of eight cytotoxic drugs, administered simultaneously, has been used in 86 cases of acute leukemia. The regimen, designated TRAMPCOL, incorporated thioguanine, rubidomycin, (daunorubicin), ytosine arabinoside, methotrexate, prednisolone, cyclophosphamide, vincristine, and usually Lasparaginase. Treatment was administered in five-day pulses with treatmentfree intervals varying from nine to 23 days. Subjective and objective toxic effects were not more severe than those seen with two-and four-drug regimens previously employed. Substantial clinical and hematologic improvement occurred in 8/19 patients with chronic granulocytic leukemia (CGL) in acute transformation. Complete clinical and hematologic remission (CR) was achieved in 3/7 patients with untreated acute myeloid leukemia (AML), 5/19 patients with AML who had failed to achieve CR with other therapy, and 4/18 patients with AML in relapse after CR obtained with regimens other than TRAMPCOL. CR occurred in 15/17 patients with acute lymphocytic leukemia (ALL), most of whom had had multiple previous relapses. CR was not achieved in four patients with AML superimposed on pre-existing myeloproliferative disorders. The TRAMPCOL regimen merits further evaluation in CGL after acute transformation, as a primary treatment for AML, and as therapy for ALL 1) in relapse, 2) in adults, 3) in children with adverse prognostic features, and 4) in T-cell ALL.
Cancer 4O:ZO-29, 1977.
N 197 1 ONE OF US DEVISED A NEW DRUG RECI-I men for trial in patients with chronic granulocytic leukemia (CGL) which had undergone acute transformation. l9 In choosing this regimen, the factors taken into account were 1) the poor results of other treatments;'*8* 10,11,2e 2) the presence, in many cases, of multiple clones of leukemic cells, which might have diverse sensitivities to drugs;21-zs and 3) the clinical observation that responses to single agents, as measured by reduction of leukocytosis, though sometimes marked, were generally transient, and drug resistance appeared to arise very rapidly. These considerations suggested that a multiple-agent chemotherapy was desirable. The results of a four-drug regimen had been poor,8 and it was
From the Medical Research Council Leukaemia Unit,