Idarubicin in the Initial Treatment of Adults with Acute Lymphoblastic Leukemia: The Effect of Drug Schedule on Outcome

Abstract

Fifty two adults (aged 15 to 66 years) with newly diagnosed acute lymphoblastic leukemia (ALL, n = 47) or lymphoid blast phase chronic myelogenous leukemia (Ly-CML, n = 5) were managed with three distinct protocols containing idarubicin at a cumulative dose of36, 20, and 10 mg/m², respectively, plus vincristine, L-asparaginase, and prednisolone (IVAP-I, -2, -3). IVAP-I was highly toxic and gave a low complete remission (CR) rate (7/17, 41%). Nine patients died of complications while severely neutropenic, and one had resistant disease. In contrast, 24 of 28 patients subsequently treated with IVAP-2 achieved a CR (8696, p 0.005), the rate of both hematological and extrahematological toxicity being significantly reduced compared with IVAP-I (p <0.05). With NAP-3, 6/7 patients aged >60 years achieved CR. IVAP-2 with total idarubicin 20 mg/m² is a very effective and well tolerated regimen for the initial treatment of adults with ALL.

Key Words:

• Idarubicin ALL
• remission induction