Gm. Crooks et Jk. Sato, IFOSFAMIDE AND ETOPOSIDE IN RECURRENT CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA, Journal of pediatric hematology/oncology, 17(1), 1995, pp. 34-38
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.