ARAC-DNR for 59 yrs. or younger INDUCTION (7+3): Cytarabine 100-200 mg/m2 CIV days 1-7 Daunorubicin 30- 45 mg/m2 IVB* days 1-3 *Daunorubicin dose is 30 mg/m2 for patients 60 years of age and older, and 45 mg/m2 for those under 60. If leukemia is persistant, additional induction cycles are given: Cytarabine 100 mg/m2 CIV days 1-5 Daunorubicin 30 or 45 mg/m2 IVB* days 1 & 2 Maintenance is complex; see reference for details. Ref: Yates J, et al: Blood 60:454 (1982). ------------------------------------------------------------ Other 7+3 Regimen: CYTARABINE 100 mg/m2 CI DAYS 1-7 IDARUBICIN 12 mg/m2 IV DAYS 1-3 CYTARABINE 100 mg/m2 CI DAYS 1-7 MITOXANTRONE 12 mg/m2 IV DAYS 1-3 ------------------------------------------------------------ 5+2 INDUCTION Regimen: REF:Fisher DS. Knobf MT, Durivage HJ, eds. The Cancer Chemotherapy Handbook, 4th ed. St. Louis, MO:CV MOSBY 1993:314-315 CYTARABINE 100 mg/m2 CI DAYS 1-5 DAUNARUBICIN 45 mg/m2 IV DAYS 1-2 OR CYTARABINE 100 mg/m2 CI DAYS 1-5 MITOXANTRONE 12 mg/m2 IV DAYS 1-2 ------------------------------------------------------------ MTZ-ARAC INDUCTION Mitoxantrone 12 mg/m2 IV/30min days 1-3 Cytarabine 100 mg/m2 CIV days 1-7 if complete remission is not achieved, give: Mitoxantrone 12 mg/m2 IV/30min days 1 & 2 Cytarabine 100 mg/m2 CIV days 1-5 REF: Arlin ZA: Novantrone: Worldwide Clinical Experience. Symposium, December (1988) (abstract). ------------------------------------------------------------ IDA-ARAC (Induction) INDUCTION Idarubicin 12 mg/m2 IV days 1-3 Cytarabine 100 mg/m2 CIV days 1-7 Repeat if luekemia persists on day 14 bone marrow. CONSOLIDATION Thioguanine 100 mg/m2 PO q12h X 10 doses Cytarabine 100 mg/m2 IV q12h X 10 doses Idarubicin 15 mg/m2 IV day 1 of each program Repeat cycle every 21 to 28 days. MAINTENANCE Cytarabine 100 mg/m2 CIV days 1-5 Idarubicin 12 mg/m2 IV days 1 & 2 Repeat cycle every 13 weeks for 4 cycles. Ref: Volger WR, et al: Semin Oncol 16:21 (1989). ------------------------------------------------------------ High Dose ARAC + DNR Cytarabine 2000-3000 mg/m2 IV q12h days 1-4 or 5 Daunorubicin 30- 45 mg/m2 IVB days 4-6 Ref: Herzig RH, et al: Blood 62:361 (1983). Herzig RH, et al: J Clin Oncol 5:927 (1987). Hoaglund HC, et al: JAMA 235:1888 (1976). ------------------------------------------------------------ High Dose ARAC for consolidation Cytarabine 3000 mg/m2 IV q12h days 1, 3& 5 ------------------------------------------------------------ CMA-676 Acetaminophen 650 mg orally and diphenhydramine 25 to 50 mg intravenously 15-30 minutes before infusion of CMA-676 CMA-676 9-mg/m2 2-hour intravenous infusion Blood, Vol. 93 No. 11 (June 1), 1999: pp. 3678-3684 . ------------------------------------------------------------ ARSENIC ARSENIC TRIOXIDE 0.15 mg/kg IV QD until remission, not to exceed 60 doses. REF: Cell Therapeutics, INC, Trioxide package insert. 2000 ------------------------------------------------------------ ATRA All-trans-retinoic acid (ATRA) 45 mg/m2/day PO (1 or 2 divided doses) Start 2 days before induction chemotherapy REF:Blood 85:2643, 1995 ------------------------------------------------------------
Journal of Clinical Oncology, Vol 20, Issue 15 (August), 2002: 3249-3253
Phase I Study of Temozolomide in Relapsed/ Refractory Acute Leukemia
20 patients (16 with AML, 2 with ALL, & 2 with CML in blastic phase) received 43 cycles of temozolomide. Patients began treatment at 2 different dose levels: 200 mg/m2/d x 7 days or 200 mg/m2/d x 9 days.
RESULTS: Prolonged aplasia was the dose-limiting toxicity, and the maximum-tolerated dose was 7 days of temozolomide. Overall treatment was well tolerated: hospitalization was required in only nine of 43 courses, & there were no treatment-related deaths. 2 patients obtained a complete response, and two others met criteria for complete response except for platelet recovery. Overall, 9 of 20 patients had a significant decrease in bone marrow blasts after temozolomide treatment.
CONCLUSION: Temozolomide was well tolerated & had significant antileukemic activity when given as a single agent. Further studies of temozolomide in hematologic malignancies are indicated |