Induction Chemotherapy with N(4)-behenoyl-1-beta-D-arabinofuranosylcytosine, Idarubicin and 6-Thioguanine in Childhood Acute Myelogenous Leukemia / 대한소아혈액종양학회지

PURPOSE: Retrospective study was performed to evaluate the survivals, remission rate and complications of induction chemotherapy using N(4)-behenoyl-1-beta-D-arabinofuranosylcytosine (BH-AC), idarubicin and 6-thioguanine (6-TG) in newly diagnosed childhood acute myelogenous leukemia. METHODS: From July 1994 to March 2000, 40 children (male 30, female 10) were enrolled in the study. From day 0 to 6 of induction, BH-AC 300 mg/m(2)/day was administered intravenously over 3 hours and from day 7 to 9, dosage was adjusted according to residual leukemic blasts in day 7 bone marrow aspirates. Idarubicin 10 mg/m(2)/day was administered intravenously over 15 minutes from day 0 to 2 and 6-TG 100 mg/m(2)/ day orally divided in two from day 0 to 6. Median age at diagnosis was 4.4 years (1 month~14.9 years) with a distribution according to the FAB classification of 1 M1, 10 M2, 13 M4, 5 M4E, 7 M5a, 3 M6 and 1 M7. RESULTS: Complete remission (CR) rate was 82.5% (33/40) with one cycle of induction chemotherapy and 90.0% (36/40) with additional cycle (BH-AC and idarubicin). One patient achieved partial remission with one cycle and was lost to follow-up, and 3 died of septic shock with disseminated intravascular coagulopathy during induction. Median time to CR from diagnosis was 28 days (25~68) and recovery from neutropenia (ANC> 1,000/muL) was achieved on median day 24 (21~44). All 40 patients had a fever during neutropenic period. Toxicities such as diarrhea, mucositis, nausea and vomiting were observed over half of the patients but tolerable and transient. Five-year overall, relapse- free and event-free survivals were 54.0%, 51.1% and 46.7%, respectively. CONCLUSION: These data show that this regimen is superior to others with high remission rate and well tolerated.

Therapeutic Effect and Prognostic Analysis of Induction Chemotherapy with Idarubicin/BH-AC in Acute Myelogenous Leukemia / 대한혈액학회지

BACKGROUND: We have analyzed the outcome and prognostic factors for 61 patients with acute myelogenous leukemia (AML) who were treated with idarubicin(IDA)/N 4-behenoyl- 1-beta-D-arabinofuranosylcytosine(BH-AC) regimen at Chonnam National University Hospital between April 1994 and December 1998. METHODS: Fifty-six patients with newly diagnosed AML and 5 patients failed by IDA/ara- C were eligible to analysis. Remission induction chemotherapy consisted of IDA (12 mg/m2/day IV over 30 minutes on days 1~3) and BH-AC (age 40 years: 200 mg/m2/day). After achievement of a complete remission (CR), four polychemotherapy cycles, allogeneic BMT or autologous PBSCT were given as consolidation. RESULTS: Median age was 38 years (range, 17 to 65). Of 61 patients, 43 (70.5%) achi-eved CR and 6 (9.8%) died of early complications. The Kaplan-Meier estimated overall survival rate was 51.8+/-7.7%, 43.1+/-8.5% and 29.6+/-8.8% at 1 year, 2 year and 3 year respectively, and the disease free survival rate was 58.4+/-9.7%, 43.3+/-10.4% and 24.0+/-12.2 % at 1 year, 2 year and 3 year, respectively. Unfavorable prognostic variables for achieving CR were age >55 years (P =0.006), FAB subtypes (P=0.005) and poor risk cytogenetic abnormalities (P=0.021), and FAB subtypes for overall survival (P=0.0064). CONCLUSION: IDA/BH-AC combination chemotherapy is an effective and well-tolerated regimen for induction treatment of AML.

Induction Chemotherapy with BH-AC, Idarubicin, and 6-Thioguanine in Childhood Acute Myelogenous Leukemia

PURPOSE: We have undertaken this study to evaluate the effects of induction chemotherapy involving BH-AC, idarubicin, and 6-thioguanine (6-TG). METHODS: BH-AC 300mg/m2/day was administered intravenously over three hours for seven consecutive days. Idarubicin 12mg/m2/day was administered intravenously for three days. 6-TG 100 mg/m2/day was administered orally for seven days. Intrathecal ara-C was administered on the first day of treatment. RESULTS: Complete remission (CR) was achieved in 18 cases (66.7%), partial remission (PR) was achieved in 2 cases (7.4%). In previously untreated patients, complete reimission rate was 92.9% (13/ 14), in relapsed patients, 40% (2/5) and in the refractory patients, 37.5% (3/8). The remission duration until December 1996 was 45 to 630 days (median 133). Duration of the neutropenia (ANC<500/microliter) was 0 to 38 days (median 24). Side effects were nausea, vomiting (7/27, 25.9%), liver dysfunction (1/27, 3.7%), skin eruption (1/27, 3.7%), and mucositis (1/27, 3.7%). In all cases, fever developed in the neutropenic state (culture proven sepsis in 5 cases). Death occurred in 5 cases who achieved CR due to sepsis after chemotherapy (4 cases), intracerebral hemorrhage after bone marrow relapse (1 case). CONCLUSION: BH-AC, idarubicin, and 6-TG induction chemotherapy could be a useful induction chemotherapy treatment that combines supportive care for infection and bleeding.