[A case of refractory acute lymphocytic leukemia who achieved a complete remission by mitoxantrone]

A 21-year-old male was diagnosed as having acute lymphocytic leukemia in March 1982. The patient was immediately treated with VENP [vincristine (VCR), Endoxan (EX), Natulan, prednisolone (Pred)] therapy, yielding a partial remission. After one course of AAAP [ACNU, adriamycin (ADM), methotrexate (MTX), Pred] therapy, a combination chemotherapy with behenoyl-arabinocytosine, daunomycin (DM), vindesine and Pred was administered, which produced a complete remission lasting for 52 days. For the relapse, L-Asparaginase (L-Asp) and Pred therapy, large doses of MTX, the combination chemotherapy with VCR, EX, L-Asp and Pred and VEMP (VCR, EX, 6-MP, Pred) therapy were administered consecutively, PR was maintained but CR was not achieved. While receiving the combination chemotherapy consisting of VCR, EX, carbocone and Pred, the leukemic cells of his bone marrow increased gradually and reached to 70%; at that time cumulative doses of DM and ADM reached to 360 mg and 120 mg respectively. Thereafter mitoxantrone (MX) was administered on a 5-day iv schedule using daily dose of 4 mg/m2. Leukopenia was prolonged and liver dysfunction appeared, and they were recovered gradually. Two additional courses of MX using the same schedule and daily dose were given combined with Pred. Prolonged leukopenia and transitional liver dysfunction were also observed. He attained a CR, which was of short duration. It was clinically indicated that MX did not have a complete cross-resistance with many antileukemic agents including DM and ADM.