ACUTE LYMPHOBLASTIC LEUKÆMIA TREATED WITH A COMBINATION OF PREDNISONE, VINCRISTINE, AND RUBIDOMYCIN: Value of Pathogen-free Rooms

Abstract

A combination of prednisone, vincristine, and 'Rubidomycin' was given to 11 children with untreated acute lymphoblastic leukæmia, and complete remissions were obtained in all cases. The quality of the remissions was striking, and detailed investigation to detect persisting leukæmic cells—consisting of leucoconcentration, examination of marrow from six different sites, examination of the cerebrospinal fluid, and estimation of ornithine-carbamyl-transferase levels—was negative in 9 out of 11 cases. The same combination given to 5 children with acute lymphoblastic leukæmia during their first or second relapse induced remissions in 4 cases. Detailed investigation was negative in 3 cases. 3 out of 5 adults treated passed into remission, and in 2 of these cases the detailed investigation was negative. This drug combination thus represent a striking advance in the treatment of primary acute lymphoblastic leukæmia because of both the high frequency of remissions and the quality of the remissions—that is, the reduction of the leukæmic-cell population. Owing to the rapidity with which remissions are induced, the neurological side-effects of vincristine and the cardiac effects of rubidomycin can be avoided. In acute leukaemia complicating lymphosarcoma only 2 remissions were obtained in 6 patients treated. Use of this drug combination is commonly complicated by myeloid aplasia; but infectious complications can be avoided if the patient is placed in a pathogen-free room. The bone-marrow aplasia is only transitory, and recovery is sufficiently complete to allow subsequent maintenance chemotherapy to be instituted.