TREATMENT OF REFRACTORY AND RELAPSED ADULT ACUTE-LEUKEMIA USING A UNIFORM CHEMOTHERAPY PROTOCOL

Twenty-nine adult patients with relapsed (21) or refractory (8) de nov o acute leukemia (12 ALL and 17 ANLL) were treated with a remission-in duction salvage chemotherapeutic protocol including vindesine, mitoxan trone, cyclophosphamide, intermediate-dose cytosine arabinoside, predn isolone and methotrexate. Ten of seventeen (59%) ANLL and 8/12 ALL (67 %) achieved complete remission (CR). Seven of eight (86%) cases refrac tory to first-line remission-induction therapy (3/4 ANLL and 4/4 ALL) entered complete remission. The most frequent non-hematologic side eff ects were gastrointestinal. All patients experienced severe pancytopen ia, with median times to recovery of granulocyte and platelet counts o f 28 and 29 days, respectively. Nine of twenty-nine (31%) patients suf fered febrile episodes of unknown origin and 13/29 (45%) suffered docu mented infections. Five patients (17%) died while aplastic, four from infection and one from cardiotoxicity. Four patients who entered CR we re submitted to a bone marrow transplantation (BMT), two autologous an d two allogeneic BMT. Sixteen of the 18 patients who entered CR relaps ed, with a median remission duration of 3.5 +/- 2.9 months. Two patien ts remain in remission at 5+ and 17+ months. These results suggest tha t this protocol is an effective remission-induction salvage therapy fo r adult acute leukemias.