Preliminary results of consolidation therapy with high-dose cytosine arabinoside for patients with bad-risk or relapsed acute leukemia or lymphoblastic non-Hodgkin's lymphoma

Abstract

High-dose Ara-C consolidation therapy for patients with primary refractory or relapsed acute leukemia (AML and ALL) or relapsed lymphoblastic non-Hodgkin's lymphoma (LNHL) was investigated. Between January 1983 and January 1986, 47 adult patients with primary refractory or relapsed AML, ALL or lymphoblastic NHL received a remission induction regimen that included intermediate-dose Ara-C (1g/m22hr q 12hr × 12). Of the twenty-nine (61.7%) patients who achieved complete remission sixteen (AML 9, ALL 5, LNHL 2) received 1–3 consolidation courses that included high-dose Ara-C (3g/m2 q 12hr × 8). Three patients died as a result of major infections during the pancytopenic phase that followed the first consolidation course and 6 relapsed at 4, 4, 6, 8, 9 and 16 months; at the moment of this report the remaining 7 patients have been in continued remission for 8 to 28 months (6 have been in continued complete remission for ⩾ 11 months). The predicted median disease-free interval for patients who survived consolidation therapy is 16 months. Of the 13 patients who did not undergo consolidation chemotherapy 2 subsequently underwent allogeneic bone marrow transplantation and 3 died as a result of major infectious complications while in complete remissiion. Eight patients received no further treatment because they refused or had previously experienced severe toxicity. The median disease-free interval for this group was only 3 months. Our preliminary data on brief intensive consolidation therapy for patients with relapsed or primary refractory leukemia or non-Hodgkin's lymphoma suggest that this kind of treatment prolongs disease-free interval.