Treatment of Chronic Myelogenous Leukemia in Blast Crisis and- in Accelerated Phase with High- or Intermediate-dose Cytosine Arabinoside and Amsacrine

Abstract

Twenty-two patients (mean age 41 years) in blast crisis or accelerated phase (AP) of chronic myelogenous leukemia (CML) were treated with cytosine arabinoside (Ara-C) 500 mg/m² [intermediate dose] or 1000 mg/m² [high dose] twice a day for 6 days and amsacrine (AMSA) 120 mg/m² for 3 days. Twenty-one cases were of myeloid type and one was a lymphoid BC. The mean duration of aplasia (neutrophils < 0.5 × 10⁹/1) was 21.5 days. Four patients (18%) died of infection during aplasia and minor toxicities were noted for the remainders. Nine patients (41%) achieved a complete remission (CR) and 4 (18%) a partial response. Various additional therapies were proposed after induction treatment including allogeneic bone marrow transplantation (2 patients), Ara-C and AMSA maintenance or other regimens with or without alpha-interferon (9 patients). Median survival for the entire cohort was 20 weeks (wks), significantly superior for complete responders (37 wks) than for others (7 wks) (p = 0.008). In this study, age, sex, initial platelet or basophil counts, interval between diagnosis of CML and blast crisis were not predictive of response. Although inducing a high CR rate and associated with acceptable toxicity, this regimen did not improve the survival of patients with BC of CML, strengthening the need for alternate approaches to be defined.

Key Words:

• Amsacrine
• cytosine arabinoside
• chemotherapy
• CML
• blast crisis