IFOSFAMIDE AND ETOPOSIDE IN RECURRENT CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA

Purpose: The activity of the drug combination ifosfamide and etoposide (VP16) in refractory and relapsed childhood acute lymphoblastic leuke mia (ALL) was assessed in a phase II study. Patients and Methods: Twen ty children with ALL, all heavily pretreated and in bone marrow relaps e, were entered on the study. Drugs were given i.v. each day for 5 day s at the following doses: ifosfamide 1.8 g/m(2)/day, VP16 100 mg/m(2)/ day, and MESNA 2,880 mg/m(2)/day (as a uroprotectant); cycles were rep eated every 28 days. At study entry, eight patients were in first rela pse (five of whom had failed intensive reinduction regimens), seven we re in second relapse, and five were in third relapse. All patients had received cyclophosphamide in regimens before relapse. Results: Eight patients (40%; 95% confidence interval 19-64%) achieved complete bone marrow remission with ifosfamide/VP16. Three patients subsequently rel apsed in the bone marrow while on ifosfamide/VP16 therapy. Duration of remission ranged from 21 to 247 days. Treatment was generally well to lerated, with myelosuppression the most common toxicity; fever and neu tropenia occurred in 18 of 31 evaluable cycles. Conclusion: The combin ation of ifosfamide/VP16 has significant activity in recurrent and ref ractory childhood ALL with tolerable toxicity.