Faculty Collaboration Database

Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia. Leuk Lymphoma 2001 Apr;41(3-4):321-31

Date

05/30/2001

Pubmed ID

11378544

DOI

10.3109/10428190109057986

Scopus ID

2-s2.0-0034990346 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

We did a retrospective analysis on the safety and efficacy of sequential infusion fludarabine and cytosine arabinoside (ara-C) in treating refractory, recurrent or poor prognosis acute leukemia in adult patients. Forty-five adult patients with acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) received a total of 68 courses of sequential continuous infusion of fludarabine for 2 days (total dose 71.5 mg/m(2) ) followed by 3 days of ara-C (total dose 7590 mg/m(2) ). Thirty-nine patients had refractory or recurrent disease, and six had other adverse prognostic features. Thirty-six patients had AML, seven had ALL, and two had CML in blastic phase. Complete remission was seen in 20 patients (44%), and partial remission in 5 patients (11%), giving a total response rate of 56%, similar for both AML and ALL. Duration of response to prior therapy did not affect the response rate. All 3 patients with Philadelphia chromosome positive ALL obtained complete remission. Median remission duration was 4.7 months (range 0.6-36.6), and median overall survival was 5.0 months (0.7-40+). Median overall survival was 10.1 months in responders. Pulmonary toxicity was seen in 8 patients, of whom 2 died from adult respiratory distress syndrome. No cardiac toxicity was observed, but 3 patients had transient cerebellar toxicity. Profound myelosuppression was seen in all patients. We conclude that the sequential infusion of fludarabine and ara-C is an effective non-cardiotoxic regimen for adults with refractory, recurrent or poor prognosis acute leukemia, may be particularly useful for resistant Philadelphia chromosome positive ALL, and may warrant further investigation in this subset. Pulmonary rather than neurological toxicity may be a unique side effect of the regimen.

Author List

Vidarsson B, Abonour R, Williams EC, Woodson RD, Turman NJ, Kim K, Mosher DF, Wiersma SR, Longo WL

Author

Walter L. Longo MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Cohort Studies
Cytarabine
Cytogenetic Analysis
Disease-Free Survival
Drug Administration Schedule
Female
Hematologic Diseases
Humans
Infusion Pumps
Leukemia
Lung Diseases
Male
Middle Aged
Nervous System Diseases
Prognosis
Recurrence
Retrospective Studies
Survival Rate
Treatment Outcome
Vidarabine