Efficacy of fludarabine, intermittent sequential high-dose cytosine arabinoside, and mitoxantrone (FIS-HAM) salvage therapy in highly resistant acute leukemias.

摘要: Patients with refractory acute leukemias after intensive induction and salvage attempts have a particularly poor prognosis therapeutic options are limited. In the current study, pharmacologically based FIS-HAM regimen was applied, which included fludarabine 15 mg/m2 q 12 h (days 1, 2, 8, 9), cytosine arabinoside as 45-min infusion every 3 at 750 per single application mitoxantrone 10 3, 4, 10, 11). Twenty-six intensively pretreated patients [median age: 38 years; range: 22–65; 16 cases of myeloid leukemia (AML) lymphoblastic (ALL)] were included. Of AML, 5 achieved complete remission (CR, 31%), 1 partial (PR, 6%), 2 nonresponders (13%), 8 succumbed to early death (ED, 50%). ALL, CR, PR, nonresponder, died early. Overall, CR rate 38%. The median disease-free survival time 50 days 90 days. Two underwent allogeneic bone marrow transplantation alive 27 28 months. Neutropenia amounted 46 Toxicity WHO III/IV infection (61%), diarrhea (48%), nausea/vomiting (43%), impairment heart function (30%), mucositis (26%). data indicate significant activity chemotherapy in advanced leukemias. However, due its pronounced toxicity, this should be restricted third-line therapy for expecting suitable donor transplantation, supportive treatment optimized.