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Short remission durations in therapy-related leukemia despite cytogenetic complete responses to high-dose cytarabine.
- Source :
-
Blood [Blood] 1988 Oct; Vol. 72 (4), pp. 1333-9. - Publication Year :
- 1988
-
Abstract
- Seventeen patients with therapy-related myelodysplastic syndrome (t-MDS) or therapy-related acute nonlymphocytic leukemia (t-ANLL) were treated with single-agent high-dose cytarabine (HDAC; 1 to 3 g/m2 every 12 hours for 12 doses). The initial neoplasm was still present in eight patients when t-MDS/t-ANLL developed. Fifteen of the 16 patients with chromosomal abnormalities in bone marrow cells had loss or rearrangement of chromosomes 5 and/or 7. One patient had a t(15;17), and one had inadequate material for cytogenetic analysis. Twelve patients had normal metaphase cells (3% to 71%). Indications for HDAC therapy were progressive pancytopenia in 13 patients or rising blast count in four. Five patients died of marrow hypoplasia following therapy. Four others had refractory t-ANLL and died within the subsequent 5 months. Only one of ten patients with a poor performance status (PS greater than or equal to 2 using the ECOG scale) achieved a complete remission, but all seven patients with a good performance status (PS less than or equal to 1) had a complete remission. Hematologic remissions were achieved in 8 patients (47%) after one (6 patients) or two (2 patients) induction courses and were confirmed by recovery of a 100% normal marrow karyotype in six of the seven patients who were retested. Patients in remission received one to four consolidation courses with HDAC alternating with cytarabine/doxorubicin, but seven relapsed within 8 months (median remission duration, 5 months). In every case, the original chromosomal abnormality reappeared at relapse. HDAC has a high response rate for good-performance patients with t-MDS/t-ANLL, but complete remissions are short even when confirmed cytogenetically and consolidated intensively.
- Subjects :
- Adult
Aged
Biopsy, Needle
Bone Marrow drug effects
Bone Marrow pathology
Chromosome Aberrations drug therapy
Chromosome Disorders
Cytarabine administration & dosage
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Leukemia, Myeloid, Acute genetics
Leukemia, Myeloid, Acute psychology
Male
Middle Aged
Myelodysplastic Syndromes genetics
Myelodysplastic Syndromes psychology
Remission Induction
Cytarabine therapeutic use
Leukemia, Myeloid, Acute drug therapy
Myelodysplastic Syndromes drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0006-4971
- Volume :
- 72
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 3167210