mercaptopurine and enocitabine

The patient was a 62-year-old man. His hematological data in April 2000 had shown no abnormalities, but he was referred to our hospital because of a fever and leukocytosis in June 2000. The peripheral blood showed 29.8 x 10(9)/L white blood cells, with 68.0% blasts. A bone marrow aspirate showed hypercellularity with a proliferation of large leukemic blasts. The leukemic cells were positive for CD13 (91%), CD33 (54.8%), CD34 (94.5%), and HLA-DR (97.9%). Some leukemic cells (15.6%) also expressed CD14. Cytogenetic analysis revealed 92,XXYY,t(9;22)(q34;q11)x2 in all 20 metaphase cells. Reverse transcriptase polymerase chain reaction analysis detected the minor BCR/ABL messenger RNA (mRNA) but failed to detect the major BCR/ABL mRNA. The patient achieved complete remission after induction chemotherapy, with no evidence of Philadelphia chromosome (Ph) or minor BCR/ABL mRNA. Ph-positive acute myeloid leukemia (Ph-AML) has rarely been reported. Herein, we report a case of Ph-AML with tetraploidy and review the previously reported Ph-AML cases.

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Cytarabine; Daunorubicin; Fusion Proteins, bcr-abl; Humans; Karyotyping; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Polyploidy; Prednisolone; Remission Induction; RNA, Messenger; RNA, Neoplasm

Due to advances in chemotherapy, differentiation therapy and bone marrow transplantation (BMT), adult acute myeloid leukemia (AML) has become a curable disease, and we are making further efforts to heighten the cure rate. The JALSG AML 89 study resulted in a 77% complete remission (CR) rate in 326 adults with AML, and a 38% 4.5-year disease-free survival (DFS) in CR cases. The JALSG AML92 study for APL with all-trans retinoic acid resulted in a 89% CR rate in 196 and 64% 4-year DFS in CR cases.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Cytarabine; Daunorubicin; Drug Resistance, Neoplasm; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Mercaptopurine; Middle Aged; Prednisolone; Tretinoin

We describe a 45-year-old female who developed acute myelogenous leukemia (AML) associated with a mediastinal mass. The patient achieved a complete remission accompanied by resolution of the mediastinal mass following intensive chemotherapy alone. A review of the literature disclosed ten AML patients with a mediastinal tumor; all five patients who had mediastinal granulocytic sarcoma treated by local irradiation prior to developing AML, eventually relapsed as frank leukemia and died soon afterwards. On the other hand, three of the other five patients who simultaneously developed both a mediastinal tumor and overt AML achieved complete remission with combination chemotherapy. In conclusion, intensive chemotherapy should be considered for a patient with granulocytic sarcoma of the mediastinum, irrespective of the concomitant leukemia.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Follow-Up Studies; Humans; Leukapheresis; Leukemia, Myeloid, Acute; Mediastinal Neoplasms; Mercaptopurine; Middle Aged; Prednisolone; Radiography, Thoracic; Remission Induction; Time Factors; Tomography, X-Ray Computed

We report here a patient with acute lymphoblastic leukemia (ALL) in whom hypofibrinogenemia developed during chemotherapy. The patient was a 65-year-old female who was diagnosed as having common ALL, and she was treated with BHAC-DMPV (enocitabine: 160 mg, daunorubicin : 40 mg, 6-MP: 35 mg, prednisolone (PSL): 60 mg, and vincristine: 2 mg). Hypofibrinogenemia appeared promptly each chemotherapy, including PSL was given. To ascertain a correlation between hypofibrinogenemia and the drugs given in this patient, a trial administration of PSL was attempted during a complete remission state. The level of fibrinogen, in terms of the amount of antigen or coagulability, decreased during PSL treatment, although the levels of AT III, plasminogen, alpha 2PI.Plm complex, and FDP did not change. Thus, it is difficult to speculate that PSL induced destruction of leukemia cells and release of protease from the cells resulting in fibrinolysis and hypofibrinogenemia in this case. These findings also suggest that the administration of only PSL could induce hypofibrinogenemia.

Topics: Afibrinogenemia; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Vincristine

We conducted a prospective, multicenter cooperative study to compare two courses of modified intermediate-dose cytarabine (Ara-C) (mIDAC; Ara-C at a dose of 1.0 g/m(2) every 12 hours for 5 days) versus high-dose Ara-C (HDAC; Ara-C at a dose of 2.0 g/m(2) every 12 hours for 5 days) in post-remission therapy for acute myeloid leukemia (AML) to confirm the post-remission antileukemic efficacy and safety of mIDAC.. Twenty-six newly diagnosed patients with AML underwent remission induction therapy consisted of behenoyl Ara-C, mitoxantrone, etoposide, and 6-mercaptopurine. Post-remission therapy included four courses of consolidation and four courses of intensification. Patients who achieved complete remission (CR) were randomly assigned to mIDAC or HDAC for the second course of consolidation. The third course of intensification was the same as the second course of consolidation. Other post-remission therapies were the same in each group.. Twenty-two patients (84.6%) achieved CR and 21 patients were randomly assigned to receive either mIDAC (n=11) or HDAC (n=10). The predicted 4-year relapse-free survival for the mIDAC group and for the HDAC group were 49% and 56%, respectively (p=0.86). Although HDAC developed severe leukocytopenia compared to mIDAC, there were no significant differences between HDAC and mIDAC in the incidence of ≥grade 3 and ≥grade 4 documented infections. The mean lowest white blood cell count (WBC) after HDAC was significantly lower than that after mIDAC (0.208±0.120×10(3)/mm(3) and 0.459±0.333×10(3)/mm(3), respectively, p<0.05). The time to WBC recovery to 2.0×10(3)/mm(3) after HDAC was significantly longer than that after mIDAC (34.3±12.1 days and 27.1±9.5 days, respectively, p<0.05).. This study suggests that mIDAC may have an equivalent post-remission antileukemic efficacy to HDAC with less myelosuppression for AML patients.

Topics: Adult; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Consolidation Chemotherapy; Cytarabine; Disease-Free Survival; Dose-Response Relationship, Drug; Drug Administration Schedule; Etoposide; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Prospective Studies; Remission Induction; Vinblastine; Vincristine; Young Adult

We investigated the prognostic significance of genetic polymorphism in glutathione-S transferase mu 1 (GSTM1), glutathione-S transferase theta 1 (GSTT1), NAD(P)H:quinone oxidoreductase (NQO1) and myeloperoxidase (MPO), the products of which are associated with drug metabolism as well as with detoxication, in 193 patients with de novo acute myeloid leukemia (AML) other than M3. Of the patients, 64.2% were either homozygous or heterozygous for GSTT1 (GSTT1(+)), while 35.8% showed homozygous deletions of GSTT1 (GSTT1(-)). The GSTT1(-) group had a worse prognosis than the GSTT1(+) group (P = 0.04), whereas other genotypes did not affect the outcome. Multivariate analysis revealed that GSTT1(-) was an independent prognostic factor for overall survival (relative risk: 1.53; P = 0.026) but not for disease-free survival of 140 patients who achieved complete remission (CR). The rate of early death after the initiation of chemotherapy was higher in the GSTT1(-) group than the GSTT1(+) group (within 45 days after initial chemotherapy, P = 0.073; within 120 days, P = 0.028), whereas CR rates and relapse frequencies were similar. The null genotype of GSTT1 might be associated with increased toxicity after chemotherapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Disease-Free Survival; Etoposide; Follow-Up Studies; Gene Deletion; Genotype; Glutathione Transferase; Humans; Isoenzymes; Leukemia, Myeloid; Mercaptopurine; Multivariate Analysis; NAD(P)H Dehydrogenase (Quinone); Neoplasm Proteins; Peroxidase; Polymorphism, Genetic; Prednisolone; Prognosis; Remission Induction; Survival Analysis; Treatment Outcome

In our previous studies, the outcome of high-risk ALL was still poor. In the present study, all children with ALL were classified into three groups and treated with a new regimen (AL90).. Between 1990 and 1996, 220 children with ALL, treated with the AL90 regimen, were classified into three risk groups: low, intermediate, and high: LR, IR, and HR, respectively. The protocol consisted of three- to five-drug induction, consolidation with intermediate-dose methotrexate and/or cytarabine, mercaptopurine and cyclophosphamide, four-drug intensification, and sequential maintenance therapies. Only intrathecal chemotherapy was used for CNS prophylaxis in the LR group, whereas cranial irradiation was added for the IR and HR groups.. The number of eligible patients was 91: LR group, 71: IR group, and 58: HR group. Complete remission (CR) was obtained in > 98% of the LR and IR groups, while only 88% achieved CR in the HR group. The 5-year event-free survival (EFS) rate was 67.4% in all patients: 70.4% in the LR group, 71.7% in the IR group, and 57.5% in the HR group. With respect to the previous study, EFS in the HR group who showed positive residual leukemia at 14 days was improved, whereas EFS in boys versus girls was significantly lower (48.8% : 85.7%, P = 0.02).. In high-risk ALL, the rate of induction failure was high and boys had a worse outcome, calling for improvements in induction therapy and a specific approach for boys.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Dexamethasone; Disease-Free Survival; Drug Administration Schedule; Etoposide; Female; Humans; Immunophenotyping; Infant; Male; Mercaptopurine; Methotrexate; Multivariate Analysis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Prognosis; Radiotherapy, Adjuvant; Remission Induction; Risk; Risk Factors; Severity of Illness Index; Sex Factors; Survival Analysis; Treatment Outcome; Vincristine

In acute myeloid leukemia (AML), p53 mutations are reportedly infrequent but associated with a poor prognosis. The majority of mutations are missense mutations, which generally lead to accumulation of nuclear p53 protein. However, the prognostic significance of the accumulation remains unknown in AML. In this study, we compared the prognostic value of p53 mutations versus accumulation of the product. p53 mutations were found in 9 (4.5%) of 200 patients with de novo AML. The p53 mutation detectable (mutation+) group had a worse prognosis (p = 0.0009) than the mutation not detectable (mutation-) group. Multivariate analysis showed that the p53 mutation was an independent factor (p = 0.005) for short overall survival as well as 60 yr or older (p = 0.001) and unfavorable karyotypes (p = 0.001). In 79 of the 200 patients, the expression of p53 was studied by immunocytochemistry (ICC) using anti-p53 monoclonal antibody (DO-7). All samples carrying missense mutations (N = 6) were positive for ICC in over 15% of nuclei of each sample, chosen as the optimized cutoff value of p53 accumulation. Accumulation was thus found in 14 of the 79 patients. However, there was no prognostic difference according to the accumulation, because the mutation-/accumulation+ group (N = 8) tended to have a good prognosis. These findings indicate that molecular detection of p53 mutations yields better prognostic information than ICC. In a subset of AML, p53 protein might be accumulated without mutation presumably due to upstream signals of p53.

Topics: Acute Disease; Adult; Aged; Amino Acid Substitution; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; DNA Mutational Analysis; Etoposide; Female; Gene Deletion; Genes, p53; Humans; Japan; Leukemia, Myeloid; Life Tables; Male; Mercaptopurine; Middle Aged; Mutation; Mutation, Missense; Neoplasm Proteins; Prednisolone; Prognosis; Regulatory Sequences, Nucleic Acid; Single-Blind Method; Survival Analysis; Tumor Suppressor Protein p53; Vincristine

We report herein the clinical results of a multicenter trial of the Japan Adult Leukemia Study Group for cases of newly diagnosed acute promyelocytic leukemia (APL) treated with all-trans retinoic acid and chemotherapy (JALSG AML-92 study). Of 196 evaluable patients, 173 (88%) achieved complete remission (CR). Multivariate analysis showed that no or minor purpura at diagnosis and age less than 30 years were favorable factors for achievement of CR. There was a significant difference in the 4-year event-free survival between the AML-92 study (54%) and both the AML-87 (32%) and AML-89 (32%) studies which consisted of intensive chemotherapy. Since prognosis in patients with APL largely depends on chemotherapy, it is important to consider more effective chemotherapy during induction and consolidation therapy.

Topics: Aclarubicin; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Disease-Free Survival; Drug Administration Schedule; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Prognosis; Receptors, Retinoic Acid; Remission Induction; Retinoic Acid Receptor alpha; Tretinoin

An intermittent and cyclic regimen with All-Trans Retinoic Acid (ATRA) and intensive chemotherapy was conducted due to pharmacokinetic studies on ATRA for acute promyelocytic leukemia (APL) in children. We have treated 17 children with APL using ATRA for remission induction followed by an intermittent schedule of ATRA plus intensive chemotherapy (APL-ATRA protocol). There were 10 males and 7 females. The median age was 9.0 years old. The median baseline white blood cell count was 12.1 x 10(3)/microliter, hemoglobin 7.8 g/dl, platelet 4.5 x 10(4) microliters at diagnosis. Sixteen patients showed t(15; 17) translocation. RT-PCR analysis was available in 15 patients and showed PML/RAR alpha rearrangement in all patients. Overall, 13 or 17 newly diagnosed patients (88%) achieved complete remission and EFS was 67%. Compared to the control (same chemotherapy without ATRA regimen), remission induction and EFS were significantly increased. The toxicity of ATRA consisted of retinoic acid syndrome in 1 and pseudotumor cerebli in another. Other toxicities included headache, chelitis, gastrointestinal trouble and bone pain. These results suggest that intermittent and cyclic regimen with ATRA and intensive chemotherapy (APL-ATRA protocol) is highly effective for APL patients.

Topics: Aclarubicin; Administration, Oral; Adolescent; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Child; Cyclophosphamide; Cytarabine; Daunorubicin; Doxorubicin; Drug Administration Schedule; Female; Humans; Leukemia, Promyelocytic, Acute; Male; Mercaptopurine; Prednisolone; Tretinoin; Vincristine

We analyzed complete remission (CR), disease-free survival (DFS), and event-free survival (EFS) rates in two groups of patients treated with either N4-behenoyl-1-beta-D-arabinosylcytosine (BHAC) or cytarabine, and analyzed DFS with or without ubenimex, a biologic response modifier.. Newly diagnosed patients with acute myeloid leukemia (AML) were randomized to receive either BHAC or cytarabine as remission-induction combination chemotherapy and two courses of consolidation therapy. After maintenance/intensification therapy, patients in CR were randomized to receive either ubenimex and no drug.. Of 341 patients registered, 326 were assessable. The age of assessable patients ranged from 15 to 82 years (median, 48). The overall CR rate was 77%: 72% in the BHAC group and 81% in the cytarabine group, and there was a significant difference between the two groups (P = .035, chi 2 test). The predicted 55-month EFS rate of all patients was 30%: 23% in the BHAC group and 35% in the cytarabine group, with a significant difference between groups (P = .0253). The predicted 55-month DFS rate of all CR patients was 38% and that of CR patients less than 50 years of age was 47%. There was no significant difference in DFS between the ubenimex group and the group that did not receive ubenimex.. Analyses of our clinical trial showed that the use of BHAC in remission-induction therapy and in consolidation therapy resulted in poorer CR and EFS rates in adult AML patients compared with the use of cytarabine at the doses and schedules tested. Immunotherapy with ubenimex after the end of all chemotherapy did not improve DFS.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Chi-Square Distribution; Cytarabine; Daunorubicin; Disease-Free Survival; Female; Follow-Up Studies; Humans; Leucine; Leukemia, Myeloid; Logistic Models; Male; Mercaptopurine; Middle Aged; Multivariate Analysis; Prednisolone; Prospective Studies; Remission Induction; Survival Rate; Treatment Outcome

We conducted a multicenter trial of treatment with all-trans retinoic acid (ATRA) for newly diagnosed acute promyelocytic leukemia (APL) in the AML-92 study and compared it with our previous study with standard intensive chemotherapy, the AML-89 study, in the view of complete remission (CR) rate, incidence of early death, and event-free survival (EFS). Patients were scheduled to receive oral ATRA 45 mg/m2 daily until CR. If patients had leukocyte counts above 3 x 10(9)/L at the start of therapy, they received daunorubicine (DNR) 40 mg/m2 for 3 days and behenoyl cytosine arabinoside (BHAC) 200 mg/m2 for 5 days in addition to ATRA. During the ATRA therapy, if patients showed myeloblast plus promyelocyte counts higher than 1 x 10(9)/L in the peripheral blood, they received additional DNR and BHAC in the same schedule, as well. A total of 110 patients were entered into the study. Median age was 43 years (range, 16 to 74). Twenty-eight (26%) of 109 patients (one died before the start of therapy) received ATRA alone. Ninety-seven patients (89%) achieved CR; 48 of 49 (98%) aged less than 40 years, 44 of 52 (84%) aged between 40 and 69, and 5 of 8 (63%) aged above 70 achieved CR, respectively; 25 of 28 (89%) with ATRA alone, 46 of 51 (90%) with ATRA plus initial chemotherapy and 26 of 30 (87%) with ATRA plus later chemotherapy attained CR, respectively. Nine (8%) patients died within 28 days after the start of therapy. In contrast, 44 of 62 patients (71%) attained CR, and 13 (21%) died within 28 days in the AML-89 study with the combination of DNR, BHAC, 6-mercaptopurine and prednisolone. Seven developed retinoic acid syndrome and one died of it in the present study. Other toxicities associated with this drug included cheilitis, desquamation, muscle pain, and hypertriglyceridemia. Predicted 23 months EFS for all ATRA-treated patients and disease-free survival (DFS) in the CR cases were 75% and 81%, respectively, in a median follow-up period of 21 months. Compared to the AML-89 study, there was a highly significant difference in remission rate (P = .004), EFS (P = .0007), and also early mortality rate (P = .02). Present results demonstrated that ATRA with or without chemotherapy gives a statistical improvement in CR rate and early mortality rate, as well as superior survival in newly diagnosed APL.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Daunorubicin; Female; Humans; Immunologic Factors; Japan; Leukemia, Promyelocytic, Acute; Leukocytosis; Life Tables; Male; Mercaptopurine; Middle Aged; Prednisolone; Prospective Studies; Remission Induction; Syndrome; Treatment Outcome; Tretinoin

Aclarubicin was evaluated in combination chemotherapy for adult acute myeloid leukemia in a randomized trial involving 58 institutions throughout Japan. Behenoyl cytosine arabinoside (BH-AC).daunorubicin, 6-mercaptopurine, and prednisolone (DMP) was compared with BH-AC.aclarubicin, 6-mercaptopurine, and prednisolone (AMP). In the 360 evaluable cases among the 433 cases enrolled, complete remission (CR) rates were 63.7% (116/182) for BH-AC.DMP and 53.9% (96/178) for BH-AC.AMP (P = 0.0587). Median survival periods and 7-year survival rates were 15.8 months and 19.3% for BH-AC.DMP and 9.5 months and 20.2% for BH-AC.AMP (P = 0.0091 according to the generalized Wilcoxon test [GW], P = 0.196 according the log-rank test [LR]). Median disease-free survival periods were 15.4 months for BH-AC.DMP and 14.1 months for BH-AC.AMP (P = 0.851 by GW, P = 0.439 by LR). Among the 346 cases of extramurally confirmed FAB subtypes, CR rates were 67.9% (19/28) with BH-AC.DMP and 31.8% (7/22) with BH-AC.AMP for subtype M3 (P = 0.011) and 63.3% (93/147) with BH-AC.DMP and 56.8% (84/148) with BH-AC.AMP (P = 0.254) for subtypes M1, M2, M4, and M5. Diarrhea, ileus, pneumonia, and renal failure were more frequent with BH-AC.AMP than with BH-AC.DMP. The results indicate, at least on the basis of the long-term outcome, that BH-AC.AMP has antileukemic effects on subtypes M1, M2, M4, and M5 that are comparable with those of BH-AC.DMP.

Topics: Aclarubicin; Acute Disease; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid; Male; Mercaptopurine; Middle Aged; Prednisolone; Prospective Studies; Survival Analysis

Topics: Acute Disease; Adult; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Communicable Diseases; Cytarabine; Daunorubicin; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid; Mercaptopurine; Prednisolone; Recombinant Proteins; Recurrence; Remission Induction; Survival Analysis; Time Factors; Vincristine

We asked 2 questions in this study. First was the additional effect of VCR in induction therapy, and the second was the duration of maintenance therapy. Adult AML were treated by an individualized response-oriented induction therapy with behenoyl Ara-C 200 mg/m2 daily + 6MP 70 mg/m2 daily + prednisolone 40 mg/m2 on days 1-4 + DNA 40 mg/m2 on days 1-3 and additionally on days 7, 8, 11, 12 (for M3, DNR 50 mg/m2 daily) (BHAC-DMP) until bone marrow became severely hypoplastic with less than 5% of blasts. Patients were randomized to BHAC-DMP or BHAC-DMP + VCR 0.35 mg/m2 on days 1-4. After obtaining CR, 3 courses of intensive consolidation therapy were given together with I.T. MTX+Ara-C+PSL. Maintenance intensification therapy was randomized to either 4 or 12 courses given every 2 months. Patients of age greater than or equal to 60 received about 2/3 reduced doses. From June 1987 to Sept. 1989, 265 consecutive adult AML were registered from 19 institutions and 258 were evaluable. Age ranged from 15 to 79 (med., 48). Out of 258, 200 (77.5%) achieved CR (80% in 209 of age less than 60 and 65% in 49 of age greater than or equal to 60). Unexpectedly, addition of VCR reduced the high CR rate of BHAC-DMP significantly (84% to 70%, p = 0.007). At the median follow-up of 37 mo., overall survival is 37%, and event-free survival (EVS) 27%. Survival, continuing CR and disease-free survival (DFS) rates of 200 CR cases are 45%, 40% and 35%, respectively. Patients received 12 courses of maintenance therapy showed better DFS (P = 0.0555). The VCR group had significantly worse EFS. By multivariate analysis, significant prognostic factors for the achievement of CR were age less than 60, PS 0-2 and no addition of VCR. Significant factors for longer DFS were induction of CR by one course, FAB M3 or M5 and age less than 50. The present multi-institutional study confirmed the high CR rates of the response-oriented individualized therapy reported from several centers in Japan, but failed to support an additional effect of VCR reported from one center.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Drug Administration Schedule; Female; Humans; Japan; Leukemia, Myeloid; Male; Mercaptopurine; Middle Aged; Prednisolone; Remission Induction; Vincristine

BHAC-MMP therapy, a combination of behenoyl-ara-C, mitoxantrone, 6-mercaptopurine and prednisolone, was applied to 49 patients with acute leukemia for remission induction. Complete remission was obtained in 6 out of 11 previously untreated patients (55%), and in 16 of 38 pretreated patients (42%). Median duration of complete remission was 41 weeks in previously treated patients, while 67% of untreated patients were still in complete remission. Most frequent side effects other than hematological toxicities were gastrointestinal disturbances, and GPT elevation etc., although most of these were not severe. In conclusion, BHAC-MMP therapy seems to be very promising for remission induction or for possible intensification treatment for acute leukemia.

Topics: Acute Disease; Adolescent; Adult; Aged; Anthraquinones; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Cytarabine; Female; Humans; Leukemia; Leukemia, Lymphoid; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Prednisolone

Topics: Acute Disease; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Child; Clinical Trials as Topic; Cytarabine; Female; Humans; Leukemia; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Prednisolone; Vincristine

Topics: Adult; Aminoglycosides; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Clone Cells; Combined Modality Therapy; Consolidation Chemotherapy; Cytarabine; Daunorubicin; Gemtuzumab; Humans; Leukemia, Myeloid, Acute; Lymphocyte Transfusion; Male; Mercaptopurine; Myeloid-Lymphoid Leukemia Protein; Neoplastic Stem Cells; Oncogene Proteins, Fusion; Prednisolone; Recurrence; Remission Induction; Reoperation; Time Factors; Transplantation, Homologous; Vincristine

A 71-year-old man was admitted to our hospital because of right lower abdominal pain. He was suspected of having acute appendicitis and soon after admission, appendectomy was performed. Macroscopically, the appendix was greatly swollen and reddened, but had no abscess. Microscopically, polymorphonuclear leukocytes were not found, but diffuse infiltration of atypical cells was observed. Examination of a bone marrow aspirate revealed 74% blasts that were peroxidase stain positive. We diagnosed acute myelogenous leukemia (FAB classification, M2). He received induction chemotherapy, but died 49 days after admission. Leukemic cell infiltration of the appendix is rare and acute appendicitis as the initial manifestation of leukemia is even rarer.

Topics: Aged; Antigens, CD; Antigens, Neoplasm; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Appendicitis; Appendix; Combined Modality Therapy; Cytarabine; Daunorubicin; Disease Progression; Fatal Outcome; Humans; Idarubicin; Immunophenotyping; Leukemia, Myeloid, Acute; Leukemic Infiltration; Male; Mercaptopurine; Sarcoma, Myeloid

We describe a 69-year-old Japanese male with acute leukemia with a CD7+ and CD56+ immunophenotype presenting with multiple lymphadenopathy. He was treated with idarubicin and cytosine arabinoside. Although the leukemia showed partial response, the patient did not achieve complete remission. He died of sepsis due to severe neutropenia after the third course of chemotherapy. His autopsy revealed blast infiltration in the lymph nodes, liver, spleen and vertebral bone marrow. Recently, CD7+ and CD56+ myeloid/natural killer precursor acute leukemia has been associated with a poor prognosis. Our case illustrates that myeloid/natural killer cell precursor acute leukemia shows some response to intensive chemotherapy for acute myeloid leukemia, but such therapy is insufficient to effect a cure. To overcome the resistance of this disease to chemotherapy, further studies should explore other treatment strategies.

Topics: Acute Disease; Aged; Antigens, CD; Antigens, CD7; Antigens, Differentiation, Myelomonocytic; Antigens, Neoplasm; Antineoplastic Combined Chemotherapy Protocols; CD56 Antigen; Cytarabine; Daunorubicin; Diagnosis, Differential; Etoposide; Fatal Outcome; Humans; Idarubicin; Killer Cells, Natural; Leukemia, Myeloid; Leukemic Infiltration; Lymphoma, Non-Hodgkin; Male; Mercaptopurine; Mitoxantrone; Myeloid Cells; Neoplastic Stem Cells; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sarcoma, Myeloid; Sialic Acid Binding Ig-like Lectin 3

We retrospectively analyzed 126 acute myelogenous leukemia (AML) patients aged > or =60 years who had all been referred to the same hematological department between 1989 and 1999. In 76 de novo AML cases, 53 patients (median age, 72 years) were treated with combination chemotherapy (CT) for remission induction. Complete remission (CR) rate was 57.1%. The median overall survival (OS) was 16 months, and the rate of 3-year OS was 28%. The favorable prognostic factors were performance status < or =2, cholinesterase > or =100 IU, and intermediate or favorable karyotype (P < .01). Seventeen patients (median age, 78 years) with hypocellular bone marrow or poor general condition were treated with low-dose cytosine arabinoside (LDAraC). In these patients, the CR rate was 50% and the median OS was 11 months, with an OS estimate at 3 years of 14%. All patients with hypocellular bone marrow who received LDAraC for 21 days achieved CR. In 50 patients who developed AML following a myelodysplastic syndrome (MDS/AML), 22 patients (median age, 74 years) were treated with CT, and 14 (median age, 74 years) patients were treated with LDAraC. The CR rates were 22.7% and 21.4%, respectively, and the median OS durations were 8 months and 11 months, respectively. There were no significant factors that would indicate a good prognosis in MDS/AML patients.

Topics: Acute Disease; Age Factors; Aged; Allopurinol; Antimetabolites, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Cholinesterases; Cytarabine; Daunorubicin; Disease Progression; Female; Humans; Japan; Karyotyping; Leukemia, Myeloid; Life Tables; Male; Mercaptopurine; Middle Aged; Myelodysplastic Syndromes; Neoplasm Proteins; Prognosis; Remission Induction; Risk Factors; Survival Analysis; Survival Rate

We report a patient who developed CD7+ therapy-related acute myeloid leukemia (t-AML) with trisomy 8 after chemotherapy for AML.

Topics: Antigens, CD7; Biomarkers, Tumor; Chromosomes, Human, Pair 8; Cytarabine; Daunorubicin; Diagnosis, Differential; Female; Humans; Leukemia, Monocytic, Acute; Leukemia, Myeloid; Mercaptopurine; Middle Aged; Neoplasms, Second Primary; Prednisolone; Trisomy

We studied fifteen patients older than 80 years of age with acute myelogenous leukemia (AML) treated between 1984 and 1996. Among 15 cases of AML including 7 de novo cases and 8 from myelodysplastic syndrome (MDS) or hypoplastic leukemia, 14 patients had complications, including cardiovascular disease, diabetes mellitus or other malignancies. Although patients with de novo AML showed high peripheral WBC counts and higher cellularity of bone marrow than those from MDS or hypoplastic leukemia, it was difficult in some cases to distinguish these types of AML from hematological findings. Of the 6 AML cases, three had entered complete remission (CR) by a standard dose of combination chemotherapy (BHAC-DMP). One CR patient has had CR for more than 9 years now with good QOL. Among the 3 patients treated by low-dose Ara-C, one attained CR but only for a short period. Four other patients received BRM, such as G-CSF or Ubenimex, and 2 patients died without chemotherapy. Since AML at more than 80 years of age is a highly heterogenous disease, it would be reasonable to give antileukemic agents according to the individual patient's condition.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Prednisolone; Quality of Life; Remission Induction

A 54-year-old female was admitted to our hospital for gingival bleeding and was diagnosed as acute promyelocytic leukemia (APL). She received induction therapy according to the AML92 protocol of the Japan Adult Leukemia Study Group (JALSG) with all-trans retinoic acid (ATRA) plus chemotherapeutic agents. She achieved complete remission, but one year later had a relapse in her external auditory canal without leukemic cell in the bone marrow. Extramedullary disease is rare in APL. This case suggests the importance of careful observation for extramedullary relapse in patients who are treated with ATRA.

Topics: Agranulocytosis; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Combined Modality Therapy; Cytarabine; Daunorubicin; Ear Canal; Female; Granulocyte Colony-Stimulating Factor; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Mercaptopurine; Middle Aged; Mitoxantrone; Neoplasm Proteins; Oncogene Proteins, Fusion; Radiotherapy; Recurrence; Remission Induction; Salvage Therapy; Tretinoin; Vindesine

We report a patient with acute myelomonocytic leukemia (AMMoL) who showed two independent point mutations of the N-ras gene at codons 12 and 13. Longitudinal analysis revealed that one mutation at codon 13 was detectable throughout his disease course and the other at codon 12 emerged as a second mutation 14 months after the diagnosis was made, at the refractory stage. Cloning to vector and subsequent sequencing confirmed that these mutations occurred in different alleles. Chromosome findings showed a simple abnormal karyotype at presentation and further karyotypic aberrations during his disease course, concomitantly with the second mutation of the N-ras gene. These findings revealed a close relationship among the disease progression, karyotypic evolution and a newly-appearing N-ras mutation.

Topics: Aclarubicin; Alleles; Antineoplastic Combined Chemotherapy Protocols; Chromosome Deletion; Chromosomes, Human, Pair 12; Chromosomes, Human, Pair 9; Codon; Cytarabine; Daunorubicin; Disease Progression; Doxorubicin; Etoposide; Fatal Outcome; Genes, ras; Genetic Vectors; Humans; Karyotyping; Leukemia, Myelomonocytic, Acute; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Point Mutation; Prednisolone; Vinblastine; Vincristine

We have examined the therapeutic effects of combination therapy of pirarubicin ((2"R)-4'-O-tetrahydropyranyladriamycin, THP) with various antitumor agents against P388 murine leukemia. THP showed a high antitumor activity in combination with various antitumor drugs, especially with cyclophosphamide (CPM), cisplatin (CDDP), mitomycin C (MMC), enocitabine (BHAC), vindesine (VDS) or methotrexate (MTX). The effects of combination therapy depended on the order of administration of THP and combined drugs. THP-preceding treatment gave more synergistic effects in combination with 5-fluorouracil (5-FU) or MTX. THP-preceding or simultaneous treatment with etoposide (ETP) indicated the higher synergistic activity than ETP-preceding one. Moreover, THP showed much higher synergistic effects in any order of the combination with CPM, CDDP, MMC, BHAC, VDS or MTX. These results suggest that THP possesses a therapeutic usefulness clinically in combination with various antitumor drugs, if the selection of drugs combined with THP and the order of administration are suitable.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Cyclophosphamide; Cytarabine; Doxorubicin; Drug Screening Assays, Antitumor; Fluorouracil; Leukemia P388; Male; Mercaptopurine; Methotrexate; Mice; Mice, Inbred BALB C; Mitomycin; Peplomycin; Vindesine

This report documents the acute toxicity of anti-leukemic chemotherapy on the fetus in utero by umbilical blood sampling. A patient with acute myelocytic leukemia diagnosed at the 23rd week of gestation received combination chemotherapy, and carried the pregnancy to successful delivery at the 34th week. During the course of pregnancy, the fetal condition was evaluated by serial real time sonograms and umbilical blood sampling through cordocentesis. Fetal hematopoiesis was preserved against maternal chemotherapeutic agents, and no developmental abnormalities were observed. This is the first attempt to evaluate the acute effects of chemotherapeutic agents on the fetus in utero by real time umbilical cord sampling.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Fetal Blood; Fetal Growth Retardation; Fetus; Humans; Infant, Newborn; Leukemia, Myeloid, Acute; Mercaptopurine; Prednisolone; Pregnancy; Pregnancy Complications, Neoplastic; Ultrasonography, Prenatal

We report a case of essential thrombocythemia (ET) that climaxed in acute myeloid leukemia after developing into refractory anemia. The male patient had ET that was stable for 8 years on carboquone therapy. However, at the age of 72 years he developed an acute terminal illness that was characterized by severe pancytopenia, circulating myeloblasts, extensive bone marrow infiltration by myeloblasts, and an abnormal karyotype [46, XY, t(8q-; 20q+)]. He subsequently died of severe bilateral pneumonia and heart failure. This case suggests that ET may be similar to polycythemia vera; progression to leukemia is unusual except after chemotherapy. Therefore, treatment of patients with asymptomatic ET may not be advisable.

Topics: Aged; Anemia, Refractory; Antineoplastic Combined Chemotherapy Protocols; Carbazilquinone; Cytarabine; Daunorubicin; Humans; Karyotyping; Leukemia, Myeloid; Male; Mercaptopurine; Prednisolone; Thrombocythemia, Essential

50-year-old male was admitted to our hospital because of gingival bleeding and fever in August 1987. The leukocyte count was 13,300/microliters with 80.5% leukemic promyelocytes and bone marrow was hypercellular with 86.4% leukemic promyelocytes. A small number of mature neutrophils containing Auer rods were seen in bone marrow. On a diagnosis of acute promyelocytic leukemia and treated with induction chemotherapy consisting of behenoyl-arabinofuranosyl cytosine (BHAC), daunorubicin, 6-mercaptopurine (6-MP) and prednisolone (PSL) was reformed. After cytoreduction, leukemic cells reappeared in the peripheral blood, concomitant with mature neutrophils having Auer rods. Vitamin D3 was not effective as a differentiation inducing agent. Complete remission was obtained in November 1987 by the reinduction chemotherapy consisting of BHAC, aclarubicin, 6-MP and PSL. In this case, neutrophils with Auer rods might have been derived from the leukemic clone and differentiation of leukemic promyelocytes by intensive chemotherapy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cell Differentiation; Cytarabine; Daunorubicin; Humans; Inclusion Bodies; Leukemia, Promyelocytic, Acute; Male; Mercaptopurine; Middle Aged; Neutrophils; Prednisolone; Remission Induction

To investigate the physiologic role of macrophage colony-stimulating factor (M-CSF) in hematological recovery from bone marrow hypoplasia, we used an enzyme-linked immunosorbent assay to measure serial changes of the serum M-CSF level during 25 intensification chemotherapy courses given to seven patients with acute non-lymphocytic leukemia who were in complete remission. Three M-CSF peaks were observed during therapy: the first peak was during or just after chemotherapy, the second peak was around the leukocyte nadir, and the third peak coincided with a rapid increase in the monocyte count. We could find no significant correlation between the height of the second peak and the time from the initiation of therapy to hematological recovery. On the other hand, there was a significant positive correlation between the height of the second peak and the interval from the last day of chemotherapy to the peak (r = 0.62, p = 0.001), and there was a significant negative correlation between the peak height and the time from the peak until hematological recovery (defined as a neutrophil count of over 500/microliters (r = -0.63, p = 0.001) and a leukocyte count of over 1,000/microliters (r = 0.55, p = 0.008)). However, we found only a weak correlation between the peak height and monocyte recovery. These data suggest that increased M-CSF levels lead to the stimulation of granulocyte progenitors, and that we can predict the time of neutrophil recovery by monitoring the serum M-CSF level and finding its peak.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Enzyme-Linked Immunosorbent Assay; Etoposide; Female; Humans; Leukemia, Myeloid, Acute; Leukocyte Count; Leukopenia; Macrophage Colony-Stimulating Factor; Male; Mercaptopurine; Middle Aged; Mitoxantrone; Predictive Value of Tests; Prednisone; Remission Induction; Vindesine

A patient with myelocytic leukemia who showed electrical alternans of the T-U wave with no change in the QRS complex following chemotherapy is described. Electrocardiogram taken 4 days later showed ventricular quadrigeminy in which the T-U wave of the first sinus beat after the ventricular premature contraction was markedly less prominent compared to the successive two sinus beats which showed marked prolongation and inverted T-U waves. The causative factors for alternans of T-U waves may include hypochloremic alkalosis with hypopotassemia and myocardial damage by anticancer drugs such as daunomycin and aclarubicin chloride used for the underlying disease.

Topics: Aclarubicin; Antineoplastic Combined Chemotherapy Protocols; Arrhythmias, Cardiac; Cytarabine; Daunorubicin; Electrocardiography; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged

Forty-one consecutive adult patients with acute myeloid leukemia (AML) were treated with an intensive individualized induction therapy of behenoyl cytarabine, daunorubicin, and 6-mercaptopurine, 29 patients (71%) achieved complete remission (CR). Patients then received three courses of intensive consolidation therapy, including intermediate-dose continuous cytarabine (400 mg/m2, for 5 days) and non-cross resistant drugs such as mitoxantron, etoposide and vincristine. During the course of the consolidation therapy, three patients died of infections and one died of myocardial infarction. Four patients underwent allogeneic bone marrow transplantation. The patients then received six courses of moderately intensive maintenance therapy for 1 year. The predicted 5-year continuing CR and disease-free survival rates of the CR patients were 62% (95% confidence limit, 41% to 83%) and 53% (33% to 73%), respectively. Although the number of patients in this study is small, the present study indicated that it may be possible to cure a fairly large proportion of AML patients by chemotherapy alone, if intensive induction therapy is followed by intensive consolidation therapy.

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Etoposide; Female; Humans; Leukemia, Myeloid; Male; Mercaptopurine; Mitoxantrone; Vinca Alkaloids

38 consecutive, previously untreated adult patients with acute non-lymphocytic leukaemia (ANLL) were treated with BHAC-AMP (N4-behenoyl-1-beta-D-arabinofuranosyl-cytosine, aclacinomycin A, 6-mercaptopurine, and prednisolone) therapy between March 1980 and February 1985. 25 patients (65.8%) achieved complete remission (CR). Median CR duration and median survival of patients who achieved CR were 14, and 24 months, respectively. The Kaplan-Meier analysis revealed a probability for remaining in CR of 18.0% at 5 years. Analysis of failure cases revealed that most of them were due to resistant disease. Major toxicities were infection, diarrhoea, liver dysfunction, nausea and vomiting but these were acceptable. The results indicate that BHAC-AMP therapy is comparable to the regimen with daunorubicin and cytosine arabinoside and a further clinical trial is necessary for previously untreated adult patients with ANNL.

Topics: Aclarubicin; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Prednisolone

Topics: Aclarubicin; Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Child; Cytarabine; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Naphthacenes; Pancreatitis; Vincristine

Topics: Adult; Aged; Anemia, Refractory, with Excess of Blasts; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Chronic; Male; Mercaptopurine; Middle Aged; Myelodysplastic Syndromes; Prednisolone; Remission Induction; Vincristine

Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Combined Modality Therapy; Cranial Irradiation; Cytarabine; Daunorubicin; Doxorubicin; Humans; Hydrocortisone; Leukemia, Monocytic, Acute; Male; Meningeal Neoplasms; Mercaptopurine; Methotrexate; Prednisone; Remission Induction; Testicular Neoplasms; Thioguanine

2 patients with acute megakaryoblastic leukaemia (AMKBL) were successfully treated with a combination of aclarubicin hydrochloride (an anthracycline), enocitabine (a derivative of cytosine arabinoside) and 6-mercaptopurine (6-MP) or 6-thioguanine (6-TG). They achieved a complete remission following 1 or 2 courses. They remained well and in complete remission throughout 3 courses of consolidation therapy, a total of 9 weeks. The results of remission induction therapy of AMKBL have been reviewed in the literature. 4 of 7 adult patients, including our cases, treated with 3 drugs, anthracycline, cytosine arabinoside or its derivative and 6-TG or 6-MP, achieved a complete remission. AMKBL may not have so poor a prognosis as previously believed.

Topics: Aclarubicin; Adolescent; Adult; Aged; Antibiotics, Antineoplastic; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Cytarabine; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Naphthacenes; Thioguanine

Fifty-one consecutive previously untreated adult patients with acute myelogenous leukemia (AML) were treated with BHAC-DMP (N4-behenoyl-I-beta-D-arabinofuranosyl-cytosine, daunorubicin, 6-mercaptopurine, and prednisolone) therapy. Forty-two patients (82.4%) achieved complete remission (CR). The Kaplan-Meier analysis revealed a probability for remaining in remission of 14% and for survival of 23% at 6 years. Pretreatment factors related to the achievement of CR, such as age, French-American-British (FAB) classification and WBC at the start of treatment, were not identified. Factors related to the CR duration and survival time of the patients who had achieved CR were first analyzed by a univariate analysis with the generalized Wilcoxon test. WBC count at the start of treatment, percent of blasts in the marrow at 1 and 2 weeks after the initiation of therapy, days required until CR, number of courses of induction therapy required until CR, and days required for the disappearance of circulating blasts were identified as statistically significant prognostic factors. When these characteristics were further analyzed by the Cox multivariate regression model, the percent of blasts in the bone marrow at 2 weeks was the most important prognostic factor with a statistical significance, and WBC count at the start of treatment and days required until CR (or number of courses required to achieve CR) were also important factors, with borderline significance.

Topics: Acute Disease; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Prednisone; Prognosis; Statistics as Topic

Topics: Acute Disease; Cytarabine; Erythrocytes; Humans; Kinetics; Leukemia; Mercaptopurine

Topics: Aclarubicin; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Cytarabine; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Naphthacenes; Prednisolone

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Deoxycytidine Monophosphate; Humans; Leukemia; Mercaptopurine; Prednisolone

Sixteen of 20 patients(80%) with adult ANLL treated with B H-AC X AMP therapy attained complete remission (CR). According to the FAB classification, CR rate was 6 out of 8 (75%) for M1, 3 out of 5 (60%) for M2, 2 out of 2 (100%) for M3, and 5 out of 5 (100%) for M4. The median of remission duration in 16 patients who attained CR was 8 months and appeared to be longer in patients with M2, rather than other types, of leukemia than in those with the other types of leukemia. BH-AC X AMP therapy is highly effective for remission induction in adult ANLL and long term disease free survival could be expected by addition of appropriate maintenance therapy.

Topics: Aclarubicin; Adolescent; Adult; Aged; Antibiotics, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Female; Humans; Leukemia, Monocytic, Acute; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Naphthacenes; Prednisolone

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Deoxycytidine Monophosphate; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Prednisolone

Topics: Aclarubicin; Antineoplastic Combined Chemotherapy Protocols; Child; Cytarabine; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Naphthacenes; Prednisolone

Eight adults with acute non-lymphocytic leukemia refractory to BH-AC.DMP therapy (N4-behenoyl-1-beta-D-arabinofuranosylcytosine, daunomycin, 6-mercaptopurine and prednisolone) were treated with a combination therapy of anthracycline antibiotics: adriamycin and aclacinomycin A (AA therapy). Four of five patients, who had received neither adriamycin nor aclacinomycin A previously, achieved complete remission after one course of AA therapy with a median time to remission of 24.5 days (ranging from 21 to 31 days). Two cases were in first remission induction phase and the other two were in first of third relapse. Three cases still maintain complete remission and the durations of remission range from 3 to over 14 months. Major side effects were loss of hair (100%) and myocardial damage (64%). T wave flattening and appearance of U wave in ECG were noted a few days after receiving chemotherapy but those changes returned to normal within 2 to 3 weeks. Ventricular fibrillation was observed in one case, which was refractory to chemotherapy and complicated by sepsis and electrolytes imbalance. Thus, this regimen deserves to be tried as a remission induction in patients with refractory acute non-lymphocytic leukemia.

Topics: Aclarubicin; Adolescent; Adult; Aged; Cytarabine; Daunorubicin; Doxorubicin; Drug Resistance; Drug Therapy, Combination; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Naphthacenes; Prednisolone

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Prednisolone

Topics: Aclarubicin; Adult; Cytarabine; Drug Therapy, Combination; Female; Humans; Leukemia; Leukemia, Monocytic, Acute; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Naphthacenes; Prednisolone