Aclacinomycin A and etoposide (VP-16-213): an effective regimen in
previously treated patients with refractory acute myelogenous leukemia
JM Rowe, AY Chang and JM Bennett
Hematology Unit, University of Rochester Medical Center, NY 14642.
Thirty-five patients with acute myelogenous leukemia were treated with
aclacinomycin A (60 mg/m2/day for 5 days) and VP-16-213 (100 mg/m2/day for
5 days). All were previously treated and had relapsed or were refractory to
primary treatment. Most patients (28) had received prior DAT (daunorubicin,
cytosine arabinoside, and 6-thioguanine) induction therapy followed by one
or more courses of high-dose cytosine arabinoside (HD-Ara C) as
consolidation therapy or as treatment for relapse. One patient was in her
fourth relapse, one had relapsed acute megakaryoblastic leukemia (following
remission with DAT and HD-Ara-C), one had a treatment-induced leukemia, and
four patients were treated for primary treatment failures following two
induction courses with DAT or a similar regimen. Fourteen patients had
infections at start of therapy. Ten patients died within 14 days of
treatment, all from sepsis or bleeding, before their marrow could be
evaluated for leukemic response. Fourteen patients (40%) responded; 12
(34%) entered complete remission and two (6%) a partial remission (PR). Two
of the four patients who were treated for primary treatment failures went
into CR. The median CR duration was 99 days (range 30 to 455 days). Side
effects from this treatment were similar to the conventional DAT regimen,
although the gastrointestinal toxicity and mucositis appeared to be more
severe. In addition, two of the patients had severe but reversible
ventricular arrhythmias. The overall response (40%) and CR rate (34%) in
this group of previously treated AML patients is encouraging, and further
studies are needed to evaluate these preliminary findings.
Volume 71,
Issue 4,
pp. 992-996,
04/01/1988
Copyright © 1988 by The American Society of Hematology
