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Short remission durations in therapy-related leukemia despite cytogenetic
complete responses to high-dose cytarabine
RA Larson, M Wernli, MM Le Beau, KM Daly, LH Pape, JD Rowley and JW Vardiman
Department of Medicine, University of Chicago, IL 60637.
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.
Volume 72,
Issue 4,
pp. 1333-1339,
10/01/1988
Copyright © 1988 by The American Society of Hematology
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