Refractory anemia with excess of blasts: increased survival when treated with cyclophosphamide, methotrexate and 6-mercaptopurine

Owing to the lack of efficacious treatments for refractory anemia with an e xcess of blasts (RAEB), evaluation of other therapeutic strategies is neces sary, especially in elderly patients. We report herein our experience with an oral triple drug regimen with cyclophosphamide 200 mg/m(2) and methotrex ate 20 mg/m(2) once a week, and B-mercaptopurine 50 mg/m(2) daily for the t reatment of RAEB. Eighteen patients with a median age of 62 yr (range 17-80 ) received a triple drug regimen (TDR), and they were compared with 6 patie nts who received oxymetholone (2 mg/m(2)/d) and 9 who received supportive t herapy only. Partial response was achieved in 45% of patients receiving TDR . In 77% of patients treated with TDR the number of bone marrow blasts decr eased to <5%; however, they persisted with trilineage dyspoietic morphologi c changes. Median survival for TDR was 23 months (range 1-96), which was lo nger than that for the other groups. A slight rise in liver enzymes was the only side effect of TDR. TDR seems to be a useful alternative in patients with RAEB, a finding to be confirmed in further prospective studies.