INTERMEDIATE-DOSE OF CYTOSINE-ARABINOSIDE FOR CONSOLIDATION CHEMOTHERAPY IN ELDERLY PATIENTS WITH ACUTE NONLYMPHOCYTIC LEUKEMIA

Complete remission (CR) was achieved in 10 of 14 elderly patients (>60 years of age) with acute non-lymphocytic leukemia (ANLL) by treatment with 7-10 days of continuous intravenous infusion (iv) of cytosine arabinoside (Ara-C, 100 mg/sqm) and 3-7 days iv of daunorubicin (DNR, 30 mg/sqm). These ten patients were further treated for consolidation of CR; they received two courses of an intermediate dose of Ara-C (IDAra-C, 500 mg/sqm) every 12 hours for 6 days, in combination with 3 days of mitoxantrone (MIT, 7 mg/sqm) during the first course and in combination with 5 days of etoposide (VP-16, 100 mg/sqm) during the second course. Although marrow suppression was severe, fungal and bacterial infections were managed with conventional supportive care. Hematologic recovery following the consolidation chemotherapy was delayed 3 days compared with that observed in younger patients. Other regimen-related toxicities were well tolerated. Despite a relapse in 3 of these 10 patients, the remaining. 7 are now maintaining a state of CR for 8-30 months; the overall median CR duration is 22.8 months and the overall median survival of 14 patients is now 18.0 months. Consolidation chemotherapy consisting of IDAra-C in combination with MIT or VP-16 is therefore considered to be effective and tolerable for elderly ANLL patients who have achieved CR with conventional chemotherapy.