[Combination of AMSA-high dose cytosine arabinoside in acute leukemia]

Forty patients with refractory and/or relapsing acute leukaemia were treated with AMSA (90-120 mg/sq m/day) for 5 days combined with high dose cytosine-arabinoside (HDARAC) (3 g/sq m/12 hours) during the first 2 days. Complete remission was obtained in 46% of the 26 cases of acute myelogenous leukaemia, and the complete remission rate was fair (44%) in the 20 patients refractory to conventional induction treatments. The results were less satisfactory in the few patients with other cytological types: there were 2 complete remissions in 10 patients with acute lymphoblastic leukaemia and none in 4 patients with blast crisis of chronic myelocytic leukaemia. Haematological toxicity was severe, and 6 patients died during the aplastic phase. No cardiac toxicity associated with AMSA was observed, nor did the ocular, cutaneous or cerebellar side-effects described after longer courses of HDARAC develop. Complete remissions were relatively short, and 11 of 14 remitters relapsed after 2 to 11 months (median 4 months). However, 3 remitters underwent allogenic bone marrow transplantation with 2 surviving. Another patient has a prolonged fourth complete remission with AMSA + HDARAC maintenance treatment. It is concluded that the AMSA-HDARAC combination seems to be one of the best salvage induction regimens in acute myelogenous leukaemia.