scholarly journals Moderate dose methotrexate, vincristine, asparaginase, and dexamethasone for treatment of adult acute lymphocytic leukemia

Blood ◽  
1982 ◽  
Vol 59 (2) ◽  
pp. 334-345
Author(s):  
RJ Jr Esterhay ◽  
PH Wiernik ◽  
WR Grove ◽  
SD Markus ◽  
MN Wesley
Keyword(s):  
Median Duration ◽  
Induction Therapy ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Moderate Dose ◽  
Dose Methotrexate ◽  
Previously Treated Patients ◽  
Previously Treated

Thirty-eight adults with acute lymphocytic leukemia (ALL), 24 previously untreated and 14 previously treated, were entered into a study in which sequential, moderate-dose methotrexate and asparaginase were added to vincristine and dexamethasone (MOAD) for remission induction therapy. Eighteen of 24 previously untreated patients (75%) and 11 of 4 previously treated patients (79%) achieved a complete remission (CR). Once in CR, patients were given remission continuation therapy, which included intravenous high-dose methotrexate that was used without prophylactic cranial irradiation and without intrathecal methotrexate because of its potential activity alone as prophylaxis against central nervous system (CNS) leukemia. The median duration of CR was 11.1 mo (range 0.7–55.9+) and median survival 17.0 mo (range 0.4- 55.9+) for the 24 previously untreated patients. The median duration of CR was 7.5 mo (range 1.9–55.3+) for the 14 previously treated patients. Only 2 of 24 previously untreated patients (8.3%) developed CNS leukemia at 3.3 and 42.7 mo from start of MOAD. None of the previously treated patients developed CNS leukemia as the initial site of relapse. MOAD is useful as induction therapy for previously untreated adults with ALL, as well as for previously treated patients, and is superior to other regimens that we have used for the treatment of adult ALL.

scholarly journals Moderate dose methotrexate, vincristine, asparaginase, and dexamethasone for treatment of adult acute lymphocytic leukemia

Blood ◽  
1982 ◽  
Vol 59 (2) ◽  
pp. 334-345 ◽  
Author(s):  
RJ Jr Esterhay ◽  
PH Wiernik ◽  
WR Grove ◽  
SD Markus ◽  
MN Wesley
Keyword(s):  
Median Duration ◽  
Induction Therapy ◽  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
Remission Induction ◽  
High Dose ◽  
Moderate Dose ◽  
Dose Methotrexate ◽  
Previously Treated Patients ◽  
Previously Treated

Abstract Thirty-eight adults with acute lymphocytic leukemia (ALL), 24 previously untreated and 14 previously treated, were entered into a study in which sequential, moderate-dose methotrexate and asparaginase were added to vincristine and dexamethasone (MOAD) for remission induction therapy. Eighteen of 24 previously untreated patients (75%) and 11 of 4 previously treated patients (79%) achieved a complete remission (CR). Once in CR, patients were given remission continuation therapy, which included intravenous high-dose methotrexate that was used without prophylactic cranial irradiation and without intrathecal methotrexate because of its potential activity alone as prophylaxis against central nervous system (CNS) leukemia. The median duration of CR was 11.1 mo (range 0.7–55.9+) and median survival 17.0 mo (range 0.4- 55.9+) for the 24 previously untreated patients. The median duration of CR was 7.5 mo (range 1.9–55.3+) for the 14 previously treated patients. Only 2 of 24 previously untreated patients (8.3%) developed CNS leukemia at 3.3 and 42.7 mo from start of MOAD. None of the previously treated patients developed CNS leukemia as the initial site of relapse. MOAD is useful as induction therapy for previously untreated adults with ALL, as well as for previously treated patients, and is superior to other regimens that we have used for the treatment of adult ALL.

New Therapeutic Approach to Reduce Methotrexate Toxicity after High-Dose Chemotherapy in a Child with Acute Lymphocytic Leukemia: Efficacy and Safety of Hemoadsorption with HA-230 Adsorber

2021 ◽  
pp. 1-5
Author(s):  
Vitaliy Sazonov ◽  
Zaure Tobylbayeva ◽  
Askhat Saparov ◽  
Bolatbek Jubaniyazov ◽  
Samat Issakov ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Pediatric Patients ◽  
High Dose Chemotherapy ◽  
The Body ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Successful Implementation ◽  
Efficacy And Safety ◽  
Related Complication ◽  
Dose Methotrexate

Background: High-dose methotrexate (HDMTX) is likely to cause a number of side effects and manifest itself as hepatotoxicity, nephrotoxicity, mucositis, and neurotoxicity. A several studies demonstrated the efficacy of extracorporeal detoxification methods such as plasma exchange, hemodialysis (HD), HD filtration, and hemoperfusion for the treatment of MTX delayed clearance. However, none of the existing methods as effective as expected and limited for general implementation due to a procedure-related complication. Case Report: Here, we report a successful implementation of HA-230 hemoadsorption procedure to remove cumulated MTX from the body and reduce its toxicity in a child with ALL after high-dose chemotherapy. Results and Conclusion: Based on our results, single-hemoadsorption procedure with the HA-230 adsorber in case of delayed methotrexate clearance was safe and well-tolerated in a pediatric patient with ALL and would significantly improve the patient’s condition. Further studies need to demonstrate its safety and efficacy in a large number of pediatric patients.

scholarly journals Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia: analysis by contemporary risk classifications

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 866-869 ◽  
Author(s):  
M Abromowitch ◽  
J Ochs ◽  
CH Pui ◽  
D Fairclough ◽  
SB Murphy ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Leukemic Cell ◽  
Risk Groups ◽  
Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Average Risk ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Table Analysis

Abstract High-dose methotrexate (HDMTX) added to a basic regimen of chemotherapy proved superior to cranial irradiation and sequentially administered drug pairs (RTSC) in prolonging complete remissions in children with “standard-risk” acute lymphocytic leukemia. To extend this result to more contemporary risk groups, we reclassified the patients according to methods of the Pediatric Oncology Group (POG), the Childrens Cancer Study Group (CCG), the Rome workshop, and St Jude Total Therapy Study XI. By life table analysis, 70% to 78% of patients with a favorable prognosis would remain in continuous complete remission (CCR) at 4 years if treated with HDMTX. Uniformly lower CCR rates could be expected with RTSC, especially in St Jude better-risk patients. HDMTX also would show greater efficacy than RTSC in the CCG average-risk and POG poor-risk groups, but the results appear inferior to those being achieved with intensified regimens for high-risk leukemia. Although both therapies would provide adequate CNS prophylaxis in favorable-risk groups, RTSC would offer greater protection in patients classified as being in a worse-risk group by St Jude criteria. We conclude that HDMTX- based therapy, as described in this report, would be most effective in patients with a presenting leukocyte count of less than 25 x 10(9)/L, of the white race, aged 2 to 10 years, and having leukemic cell hyperdiploidy without translocations.

scholarly journals Evaluation of AMSA in previously treated patients with acute leukemia: results of therapy in 109 adults

Blood ◽  
1982 ◽  
Vol 60 (2) ◽  
pp. 484-490 ◽  
Author(s):  
SS Legha ◽  
MJ Keating ◽  
KB McCredie ◽  
GP Bodey ◽  
EJ Freireich
Keyword(s):  
Side Effects ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Median Duration ◽  
Optimum Dose ◽  
Remission Induction ◽  
Anthracycline Antibiotics ◽  
Blastic Phase ◽  
Previously Treated Patients ◽  
Previously Treated

AMSA was evaluated in the treatment of 109 adults with previously treated acute leukemia. Of the 102 evaluable patients, 82 had AML, 17 ALL, and 3 CML in blastic phase. A number of different dose schedules of AMSA were explored, and we conclude that the optimum dose of AMSA for remission induction in acute leukemia is 120 mg/sq m/day for 5 days. Complete remissions were observed in 23 (28%) patients with AML and in 1 patient with ALL. Patients who achieved complete remission were maintained on AMSA using a dose of 30–40 mg/sq m/day for 5 days repeated at 4-wk intervals. The median duration of complete remission was 12 wk (3–59 wk), and the responders survived significantly longer than the failures (27 wk versus 8 wk, p = 0.002). The side effects associated with AMSA therapy included mild nausea and vomiting, stomatitis, diarrhea, phlebitis, alopecia, and myelosuppression-related infections. Our results indicate that AMSA is a useful new antileukemic agent for the treatment of relapsed acute leukemia and appears to have activity comparable to that of the currently available drugs, such as cytarabine and the anthracycline antibiotics.

scholarly journals Evaluation of AMSA in previously treated patients with acute leukemia: results of therapy in 109 adults

Blood ◽  
1982 ◽  
Vol 60 (2) ◽  
pp. 484-490 ◽  
Author(s):  
SS Legha ◽  
MJ Keating ◽  
KB McCredie ◽  
GP Bodey ◽  
EJ Freireich
Keyword(s):  
Side Effects ◽  
Complete Remission ◽  
Acute Leukemia ◽  
Median Duration ◽  
Optimum Dose ◽  
Remission Induction ◽  
Anthracycline Antibiotics ◽  
Blastic Phase ◽  
Previously Treated Patients ◽  
Previously Treated

Abstract AMSA was evaluated in the treatment of 109 adults with previously treated acute leukemia. Of the 102 evaluable patients, 82 had AML, 17 ALL, and 3 CML in blastic phase. A number of different dose schedules of AMSA were explored, and we conclude that the optimum dose of AMSA for remission induction in acute leukemia is 120 mg/sq m/day for 5 days. Complete remissions were observed in 23 (28%) patients with AML and in 1 patient with ALL. Patients who achieved complete remission were maintained on AMSA using a dose of 30–40 mg/sq m/day for 5 days repeated at 4-wk intervals. The median duration of complete remission was 12 wk (3–59 wk), and the responders survived significantly longer than the failures (27 wk versus 8 wk, p = 0.002). The side effects associated with AMSA therapy included mild nausea and vomiting, stomatitis, diarrhea, phlebitis, alopecia, and myelosuppression-related infections. Our results indicate that AMSA is a useful new antileukemic agent for the treatment of relapsed acute leukemia and appears to have activity comparable to that of the currently available drugs, such as cytarabine and the anthracycline antibiotics.

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