Methotrexate plus L-asparaginase: an active combination for children with acute nonlymphocytic leukemia

Article Abstract:

Only 33 percent of children with acute nonlymphocytic leukemia (ANLL) are likely to be long-term survivors. Although more than 70 percent can achieve remission with aggressive chemotherapy, most will relapse. Currently, a relapse eliminates the likelihood of a cure for that patient. Bone marrow transplantation is a promising technique for treating ANLL, but the operation is expensive; many children lack suitable donors; and half will die of relapse, or complications due to the operation itself. Better treatments are needed for patients with ANLL who have either failed to respond to initial treatment or who have relapsed. Regimens that include agents used in the initial therapy often require sufficiently high doses, making toxic effects the limiting factor in treatment. The combination of methotrexate and L-asparaginase was evaluated as a potential alternative in treating 41 children with ANLL. The children had either failed to respond to, or relapsed after, multiple drug chemotherapy. The combination produced some antileukemic activity with limited toxic effects, although allergic reactions to asparaginase occurred in 12 cases. A total of 35 percent of the patients responded to treatment; 20 percent (eight patients) had complete responses. Three of the patients achieving a complete response had failed to respond to the first round of chemotherapy. Unfortunately, all but one of the children has subsequently died of their disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methotrexate, Acute leukemia, Nonlymphoid leukemia, Myeloid leukemia, Asparaginase

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Teniposide (VM-26) and continuous infusion cytosine arabinoside for initial induction failure in childhood lymphoblastic leukemia: a Pediatric Oncology Group pilot study

Article Abstract:

The combination of prednisone and vincristine can produce remission in 90 percent of children with acute lymphoblastic leukemia (ALL). The inclusion of one or two additional agents in the chemotherapeutic protocol may improve the response rate to 95 percent. However, for those few patients who do not respond to initial chemotherapy, the prospects are bleak. Although some characteristics, such as the Philadelphia chromosome, are more common among children who do not respond, there is no reliable indicator that can predict failure of induction chemotherapy with any certainty. In a study of 26 children with ALL who had failed to achieve remission after initial chemotherapy, researchers evaluated a combination of teniposide and cytosine arabinoside. The protocol produced a response in 12 patients (48 percent); 10 of 17 patients with non-T-cell leukemia responded, and 2 of 9 patients with T-cell leukemia. Three responding patients were removed from the study, two for bone marrow transplantation, and one by parental request. Of the remaining nine patients, the median time to relapse was a dismal two months. Of the initial 26 patients, only one remains alive as a long-term disease-free survivor. Although a satisfactory rate of remission was achieved, the short duration of the remission suggests that the observed responses were not of good quality. More intensive therapies, such as bone marrow transplantation, may be required. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, Lymphocytic leukemia, Chemotherapy, Combination, Combination chemotherapy, Lymphoblastic leukemia in children, Acute lymphocytic leukemia, Childhood leukemia, Cytarabine

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