Clinical toxicity of chemotherapeutic agents: dermatologic toxicity.

Twenty children with acute myeloblastic leukemia were given induction and maintenance regimens combining cytosine arabinoside (ARA-C) and 6-thioguanine (TG). Two died before completing induction therapy and were considered unevaluable. Of the 18 remaining patients, 3 died shortly after induction, 2 had no response, 1 had a partial response and 12 (66%) had a complete remission (CR) lasting 4 to 68 months. Six still survive: two in their initial CR and four who relapsed but were reinduced to CR. Although no prophylactic central nervous system (CNS) therapy was given, only one patient has developed CNS involvement after diagnosis. Two girls became pregnant while on maintenance therapy. One delivered a normal, full-term infant; both she and the child are well 24 months later.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%28197709%2940%3A3%3C998%3A%3AAID-CNCR2820400306%3E3.0.CO%3B2-R

Cytosine arabinoside and 6-thioguanine in the treatment of childhood acute myeloblastic leukemia.

Treatment of acute leukemias

In order to determine whether the use of a sequence of chemotherapeutic regimens plus BCG could produce longer durations of remission in adult acute nonlymphocytic leukemia than maintenance therapy with cytosine arabinoside, 6-thioguanine, plus BCG, a randomized study was performed at Washington University. Upon achieving complete remissions with daunorubicin plus cytosine arabinoside, 14 patients were randomized to receive either: Regimen A--cytosine arabinoside, 6-thioguanine, plus BCG each month; or regimen B--sequential regimens consisting of: 1) azacytidine daily for five days; 2) cyclophosphamide plus cytosine arabinoside daily for four days, prednisone daily for five days, plus vincristine on the first day; 3) prednisone, 6-mercaptopurine, and methotrexate daily for five days plus vincristine on the first day; and 4) cytosine arabinoside, 6-thioguanine, plus BCG. Each of the sequential regimens was given during consecutive months, and the cycle was then repeated starting with the first regimen. Median duration of complete remission was 27 months for 8 patients randomized to receive Regimen A, compared to only seven months for 6 patients receiving Regimen B (P less than 0.05). The median survival time of patients on Regimen B was only 14 months, and has not yet been reached in Regimen A. At 40 months after diagnosis, 75% of patients on Regimen A remain alive (P less than 0.05). Toxicity was equal for the maintenance regimens. Therefore, maintenance therapy with cytosine arabinoside, 6-thioguanine, plus BCG may be superior to the sequence of chemotherapy regimens plus BCG which was employed.

Remission maintenance for acute nonlymphocytic leukemia: cytosine arabinoside plus 6-thioguanine versus a sequence of drug regimens.

Seit Mitte der 60iger Jahre wurden die Ergebnisse der Remissionsinduktionstherapie bei akuten Leukosen des Erwachsenen zunehmend verbessert. Dank der Zytostatika Dauno-mycin bzw. Adriamycin und Cytosin-Arabinosid liesen sich die Erstremissionsquoten von 30% auf 50–70% und sogar daruber steigern [1,2,3,15]. Damit scheint vorerst ein Optimum des therapeutisch Moglichen bei der Remissionsinduktion akuter Leukosen des Erwachsenen erreicht zu sein. Trotzdem durften die erwahnten Erstremissionsquoten nicht durchweg die Realitat des Verlaufes akuter Leukamien des Erwachsenen widerspiegeln und Anlas zu etwas ubertriebenem Optimismus sein. Sind doch nicht alle diesbezuglichen Therapiestudien frei von gewissen Auswahlkriterien hinsichtlich der Aufnahme von Patienten in ein Protokoll.

Behandlungsresultate akuter Leukosen des Erwachsenen: Erstremissionsrate, Remissionsdauer, Remissionserhaltung, Prognose des Rezidives

A series of 30 unselected patients with acute nonlymphoblastic leukemia (ANLL) was treated with combination chemotherapy, including three courses of cytosine arabinoside (Ara-C) by 5-day continuous i.v. infusion, vincristine i.v. weekly, and prednisone daily to complete remission. Ara-C was administered alone as a 5-day continuous i.v. infusion monthly for maintenance. Ten (33%) achieved a complete remission (CR). The remaining 30 (67%), including temporary partial remissions, hematologic improvements, inadequate trials, and early deaths, were all considered failures. The CR rate was 57% in those 17 cases receiving an adequate trial. After After 5 1/2 years' followup, the overall median survival, including cases failing to achieve CR, was 3.1 months. For those having adequate trials the median survival was 16.6 months, and for those achieving a CR, 36.6 months. Two patients are still alive, one at 55.2 months on maintenance therapy, and the other at 62.8 months, currently unmaintained.

The role of cytosine arabinoside maintenance in acute nonlymphoblastic leukemia

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The role of cytosine arabinoside maintenance in acute nonlymphoblastic leukemia