Combination chemotherapy with risk factor-adjusted dose attenuation for high-risk myelodysplastic syndrome and resulting leukemia in the multicenter study of the Japan Adult Leukemia Study Group (JALSG): Results of an interim analysis

Forty-nine adult patients with high-risk myelodysplastic syndrome (MDS) or acute myeloid leukemia that progressed from MDS were registered for the mul ticenter study of the Japan Adult Leukemia Study Group. Forty-three patient s were evaluable for the analysis. Idarubicin 12 mg/m(2) per day for 3 days and continuous cytosine arabinoside 100 mg/m(2) per day for 7 days were gi ven as induction therapy, followed by postremission chemotherapy after comp lete remission (CR). Because elderly patients and those with hypoplastic ma rrow usually have complications after intensive chemotherapy, often causing early death, the treatment dose was reduced to 60% or 80% according to the presence of 3 risk factors: age 60 years or older, performance status 2 or more, or presence of hypoplastic bone marrow. Of the 43 evaluable patients (median age, 58 years), 26 (60%) achieved CR. Two patients (5%) died withi n 2 months of completion of induction therapy The CR rates for patients tre ated with 100%, 80%, and 60% of the chemotherapy dose were 55% (12 of 22), 63% (10 of 16), and 80% (4 of 5), respectively, indicating that the risk fa ctor-adjusted dose attenuation was appropriately applied to those who might have had problems with the original dose, thus reducing regimen-related mo rtality rate. The median overall survival of the 43 patients was 8 months. Int J Hematol. 2000,72:200-205. (C) 2000 The Japanese Society of Hematology .