THE TREATMENT OF OLDER ADULT PATIENTS WITH ACUTE MYELOID-LEUKEMIA BY TRIPLE INFUSION CHEMOTHERAPY

Adult patients (greater than or equal to 56 years old) with acute myel oid leukemia (AML) received induction therapy consisting of daunorubic in (60 mg/m(2)), etoposide (80 mg/m(2)), and cytarabine (200 mg/m(2)) daily for 5 days by continuous i.v. infusion (120 hours). The initial protocol was modified so that patients who were not hypoplastic after the first cycle of chemotherapy received a second cycle of treatment, utilizing 30 mg/m(2) of daunorubicin/24 hours for 5 days plus etoposid e and cytarabine as used in the first cycle. Two courses of consolidat ion with etoposide and cytarabine at the same dose and schedule were g iven. Patients were then maintained on cytarabine monthly. Twelve of 2 9 previously untreated patients (41%) achieved complete remission (CR) . Excluding patients with secondary AML, 48% of all patients (11/23) a chieved CR, including 56% greater than or equal to 70 years old. The m edian duration of CR was 41 weeks and median survival of CR patients w as 54 weeks. Six of 13 patients (46%) with relapsed AML achieved CR. T oxicity in these older adult patients has been mild. Two patients (8%) had severe mucositis and one had severe (bloody) diarrhea. Most patie nts developed a mild transient asymptomatic rash. Triple infusion chem otherapy (TIG) may be as effective as other chemotherapy regimens for AML in older adults and has acceptable toxicity.