Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia

B. Vidarsson, Rafat Abonour, E. C. Williams, R. D. Woodson, N. J. Turman, K. Kim, D. F. Mosher, S. R. Wiersma, W. L. Longo

Research output: Contribution to journalArticle

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Abstract

We did a retrospective analysis on the safety and efficacy of sequential infusion fludarabine and cytosine arabinoside (ara-C) in treating refractory, recurrent or poor prognosis acute leukemia in adult patients. Forty-five adult patients with acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) received a total of 68 courses of sequential continous infusion of fludarabine for 2 days (total dose 71.5 mg/m2) followed by 3 days of ara-C (total dose 7590 mg/m2). Thirty-nine patients had refractory or recurrent disease, and six had other adverse prognostic features. Thirty-six patients had AML, seven had ALL, and two had CML in blastic phase. Complete remission was seen in 20 patients (44%), and partial remission in 5 patients (11%), giving a total response rate of 56%, similar for both AML and ALL. Duration of response to prior therapy did not affect the response rate. All 3 patients with Philadelphia chromosome positive ALL obtained complete remission. Median remission duration was 4.7 months (range 0.6-36.6), and median overall survival was 5.0 months (0.7-40+). Median overall survival was 10.1 months in responders. Pulmonary toxicity was seen in 8 patients, of whom 2 died from adult respiratory distress syndrome. No cardiac toxicity was observed, but 3 patients had transient cerebellar toxicity. Profound myelosuppression was seen in all patients. We conclude that the sequential infusion of fludarabine and ara-C is an effective non-cardiotoxic regimen for adults with refractory, recurrent or poor prognosis acute leukemia, may be particularly useful for resistant Philadelphia chromosome positive ALL, and may warrant further investigation in this subset. Pulmonary rather than neurological toxicity may be a unique side effect of the regimen.

Original languageEnglish (US)
Pages (from-to)321-331
Number of pages11
JournalLeukemia and Lymphoma
Volume41
Issue number3-4
StatePublished - 2001
Externally publishedYes

Fingerprint

Cytarabine
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Therapeutics
Philadelphia Chromosome
fludarabine
Lung
Survival
Adult Respiratory Distress Syndrome
Safety

Keywords

  • Acute leukemia
  • Adult
  • Cytarabine
  • Fludarabine
  • Refractory
  • Relapsed leukemia

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Vidarsson, B., Abonour, R., Williams, E. C., Woodson, R. D., Turman, N. J., Kim, K., ... Longo, W. L. (2001). Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia. Leukemia and Lymphoma, 41(3-4), 321-331.

Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia. / Vidarsson, B.; Abonour, Rafat; Williams, E. C.; Woodson, R. D.; Turman, N. J.; Kim, K.; Mosher, D. F.; Wiersma, S. R.; Longo, W. L.

In: Leukemia and Lymphoma, Vol. 41, No. 3-4, 2001, p. 321-331.

Research output: Contribution to journalArticle

Vidarsson, B, Abonour, R, Williams, EC, Woodson, RD, Turman, NJ, Kim, K, Mosher, DF, Wiersma, SR & Longo, WL 2001, 'Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia', Leukemia and Lymphoma, vol. 41, no. 3-4, pp. 321-331.
Vidarsson, B. ; Abonour, Rafat ; Williams, E. C. ; Woodson, R. D. ; Turman, N. J. ; Kim, K. ; Mosher, D. F. ; Wiersma, S. R. ; Longo, W. L. / Fludarabine and cytarabine as a sequential infusion regimen for treatment of adults with recurrent, refractory or poor prognosis acute leukemia. In: Leukemia and Lymphoma. 2001 ; Vol. 41, No. 3-4. pp. 321-331.
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AU - Vidarsson, B.

AU - Abonour, Rafat

AU - Williams, E. C.

AU - Woodson, R. D.

AU - Turman, N. J.

AU - Kim, K.

AU - Mosher, D. F.

AU - Wiersma, S. R.

AU - Longo, W. L.

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N2 - We did a retrospective analysis on the safety and efficacy of sequential infusion fludarabine and cytosine arabinoside (ara-C) in treating refractory, recurrent or poor prognosis acute leukemia in adult patients. Forty-five adult patients with acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) received a total of 68 courses of sequential continous infusion of fludarabine for 2 days (total dose 71.5 mg/m2) followed by 3 days of ara-C (total dose 7590 mg/m2). Thirty-nine patients had refractory or recurrent disease, and six had other adverse prognostic features. Thirty-six patients had AML, seven had ALL, and two had CML in blastic phase. Complete remission was seen in 20 patients (44%), and partial remission in 5 patients (11%), giving a total response rate of 56%, similar for both AML and ALL. Duration of response to prior therapy did not affect the response rate. All 3 patients with Philadelphia chromosome positive ALL obtained complete remission. Median remission duration was 4.7 months (range 0.6-36.6), and median overall survival was 5.0 months (0.7-40+). Median overall survival was 10.1 months in responders. Pulmonary toxicity was seen in 8 patients, of whom 2 died from adult respiratory distress syndrome. No cardiac toxicity was observed, but 3 patients had transient cerebellar toxicity. Profound myelosuppression was seen in all patients. We conclude that the sequential infusion of fludarabine and ara-C is an effective non-cardiotoxic regimen for adults with refractory, recurrent or poor prognosis acute leukemia, may be particularly useful for resistant Philadelphia chromosome positive ALL, and may warrant further investigation in this subset. Pulmonary rather than neurological toxicity may be a unique side effect of the regimen.

AB - We did a retrospective analysis on the safety and efficacy of sequential infusion fludarabine and cytosine arabinoside (ara-C) in treating refractory, recurrent or poor prognosis acute leukemia in adult patients. Forty-five adult patients with acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) received a total of 68 courses of sequential continous infusion of fludarabine for 2 days (total dose 71.5 mg/m2) followed by 3 days of ara-C (total dose 7590 mg/m2). Thirty-nine patients had refractory or recurrent disease, and six had other adverse prognostic features. Thirty-six patients had AML, seven had ALL, and two had CML in blastic phase. Complete remission was seen in 20 patients (44%), and partial remission in 5 patients (11%), giving a total response rate of 56%, similar for both AML and ALL. Duration of response to prior therapy did not affect the response rate. All 3 patients with Philadelphia chromosome positive ALL obtained complete remission. Median remission duration was 4.7 months (range 0.6-36.6), and median overall survival was 5.0 months (0.7-40+). Median overall survival was 10.1 months in responders. Pulmonary toxicity was seen in 8 patients, of whom 2 died from adult respiratory distress syndrome. No cardiac toxicity was observed, but 3 patients had transient cerebellar toxicity. Profound myelosuppression was seen in all patients. We conclude that the sequential infusion of fludarabine and ara-C is an effective non-cardiotoxic regimen for adults with refractory, recurrent or poor prognosis acute leukemia, may be particularly useful for resistant Philadelphia chromosome positive ALL, and may warrant further investigation in this subset. Pulmonary rather than neurological toxicity may be a unique side effect of the regimen.

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