ISSN:
1432-0584
Keywords:
Key words Acute leukemia
;
Treatment
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The efficiency and toxicity of treatment regimens for nonintensive cytoreduction in 57 outpatients with refractory acute leukemia (mean age 56 years, 51 AML, six ALL/AUL) were retrospectively studied. Seventeen patients received one treatment regimen, 19 patients two treatment regimens, and 21 patients three or more treatment regimens. The treatment regimens analyzed were 6-thioguanine p.o. (daily) (T), 6-thioguanine p.o. (4–7 days/week) + cytarabine s.c./i.v. (once a week) (T+C), 6-mercaptopurine p.o. (daily) (MP), 6-mercaptopurine p.o. (daily) + methotrexate p.o./i.v. (once a week) (MP+MTX), etoposide p.o. (daily) (E), and mitoxantrone i.v. (M). The median leukocyte count was higher for M (73×109/l) than for the other treatment regimens (T: 27×109/l, T+C: 37×109/l, MP: 24×109/l, MP+MTX: 30×109/l, E: 31×109/l). A cytoreduction 〉50% in the peripheral blood was achieved by T in 11/19, by T+C in 7/11, by MP in 5/8, by MP+MTX in 3/6, by E in 3/4, and by M in 16/22 patients. The period of cytoreduction was regarded as the duration of response – T: median 53 days, range 5–98; T+C: median 61 days, range 14–226; MP: median 37 days, range 4–192; MP+MTX: median 58 days, range 36–59; E: median 121 days, range 26–159; M: median 39 days, range 8–78. T and T+C were well tolerated by all but three patients (stomatitis, diarrhea, WHO grade 2). MP was accompanied by a rise of transaminases (WHO 1–3) in 5/6 patients. E led to stomatitis (WHO 1,2) in 4/5 and M to nausea/vomiting (WHO 1,2) in 5/22 and to stomatitis (WHO 2) in 4/22 cases. The mean survival time after start of palliative cytoreduction was 16 weeks (2–65). In summary, 6-thioguanine ± cytarabine was best tolerated with effective but – in oral monotherapy – often protracted cytoreduction in 60% of patients. Mitoxantrone showed tolerable side effects and potent cytoreduction in 73% of patients even after ineffective palliative pretreatment. Palliative cytoreductive therapy does not reduce the quality of life and can prevent complications of significant leukocytosis in refractory acute leukemia.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s002770050568
Permalink
