mesna and Leukemia--Myeloid

Ifosfamide has previously been shown to be active as a single agent and in combination with doxorubicin, etoposide, and teniposide in pediatric solid tumors and adult acute leukemia. The authors performed a dose-escalation trial of ifosfamide with a fixed dosage of etoposide, with mesna uroprotection, in children with multiply recurrent acute leukemia.. Chemotherapy was administered daily for 5 days. Etoposide 100 mg/m2 was followed by ifosfamide at an initial dosage of 1.6 g/m2. The ifosfamide was escalated in 20% increments to the maximum tolerated dosage in cohorts of three patients. Mesna 400 mg/m2 was given immediately before the ifosfamide and then at 3 and 6 hours after ifosfamide in the initial patients. Subsequent patients were treated with mesna 400 mg/m2 just before ifosfamide, and then every 2 hours to a total dosage equal to the ifosfamide dosage.. Forty-four heavily pretreated patients were entered on study. Forty were evaluable for toxicity and 36 for response as well. The maximum tolerated dosage of ifosfamide was 4.0 g/m2/d for 5 days (20 g/m2/course). Overall, 10 patients achieved complete remission, and 3 achieved partial remission. Remissions were brief, although four patients went on to bone marrow transplant while in remission. One patient is still alive.. The combination of etoposide and ifosfamide with mesna uroprotection showed promising activity in children with multiply recurrent acute leukemia.

Topics: Acute Disease; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Bone Marrow Transplantation; Child; Drug Tolerance; Etoposide; Humans; Ifosfamide; Leukemia, Myeloid; Mesna; Neoplasm Recurrence, Local; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Urinary Tract

Topics: Acute Disease; Adolescent; Base Sequence; Biomarkers; Bone Marrow Purging; Bone Marrow Transplantation; Busulfan; Cell Separation; Child; Child, Preschool; Clinical Protocols; Combined Modality Therapy; Cyclophosphamide; Drug Resistance; Evaluation Studies as Topic; Genetic Markers; Genetic Vectors; Hematopoietic Stem Cells; Humans; Immunologic Factors; Infant; Informed Consent; Interleukin-2; Kanamycin Kinase; Leukemia, Myeloid; Mesna; Molecular Sequence Data; Phosphotransferases (Alcohol Group Acceptor); Recombinant Fusion Proteins; Remission Induction; Research Design; Retroviridae; Safety; Transplantation, Autologous

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Cyclophosphamide; Female; Furosemide; Graft vs Host Reaction; HLA Antigens; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Male; Mesna