SEQUENTIAL INDUCTION CHEMOTHERAPY WITH VINCRISTINE, DAUNORUBICIN, CYCLOPHOSPHAMIDE, AND PREDNISONE IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA

Sequential chemotherapy with vincristine, daunorubicin, cyclophosphami de, and prednisone doses was administered to 57 adult patients with ac ute lymphoblastic leukemia (ALL). Complete remission (CR) was achieved in 51 (89%, 95% confidence intervals, [CI] 78-96%). Among patients ac hieving CR, 62% were in CR after one sequence of chemotherapy, 23% aft er two sequences, and 5% after three sequences. Six patients (11%) had resistant disease. All patients experienced profound myelosuppression . Median time to recovery of neutrophils >0.5 x 10(9)/l was 22 days (r ange: 5-89 days), and of platelets >100 x 10(9)/l 21 days (range: 0-45 days). Nonhematologic WHO grade 3 or more side effects consisted pred ominantly of hyperbilirubinemia (7%), mucositis (5%), nausea and vomit ing (2%), and cutaneous toxicity (1%). Severe infectious complications occurred in only 14% of cases. One patient (2%, 95% CI 0-9%) died of therapy-related toxicity while in early CR. We concluded that sequenti al use of prednisone seemed at least as effective as continuous admini stration at the expense of a few adverse side effects.