HIGH-DOSE CYTOSINE-ARABINOSIDE AND L-ASPARAGINASE IN REFRACTORY ACUTELYMPHOBLASTIC-LEUKEMIA - THE CHILDRENS CANCER GROUP EXPERIENCE

Problem. Therapy of children with relapsed acute lymphoblastic leukemi a (ALL) not achieving a second remission (CR2) after an initial reindu ction attempt is problematic. Methods. 52 children with ALL in first r elapse received high-dose cytosine arabinoside and L-asparaginase (HDA raC/L-Asp) after failed attempts to achieve CR2. AraC was given at a d ose of 3 gm/m(2) q12 h x 4 on days 0-1 and 7-8. L-asparaginase was giv en IM 6,000 IU/m(2) 3 hours after the completion of each 2-day cycle o f AraC. Results. Of the 42 surviving to day 28, 22 (42% of ail patient s) achieved CR2. Ten died before day 28 (19%); four from leukemia and six from infections or toxicity (12% regimen related mortality). There were 17 bacterial infections (three fatal), 17 invasive fungal infect ions (12 fatal), one fatal adenoviral infection, and one non-fatal Pne umocystis pneumonia. One patient was surviving when lost to follow-up at four months and one patient survives over 5 years after transplant. Sixteen of the 22 patients who entered CR2 subsequently relapsed, fiv e died of non-leukemic causes, and one was lost to follow-up. The medi an duration of second remission was 3 months (range 0.7 to 19 months). Conclusions. HDAraC/L-Asp rescue reinduction for relapsed childhood A LL achieves CR2 in similar to 40% of patients who fail reinduction, bu t remissions are short for most patients and maintenance of CR2 remain s unsatisfactory. (C) 1998 Wiley-Liss, Inc.