Abstract
Daunorubicin (DNR) was given at doses of 1 mg/kg for 7 consecutive days in the treatment of acute promyelocytic leukemia (APL). Heparin was administered concomitantly in order to suppress disseminated intravascular coagulation which was thought to be aggravated by increased supply of procoagulant due to massive destruction of atypical promyelocytes during the DNR therapy. Complete remissions were achieved in 5 of 9 cases treated with this regimen. On the other hand, fatal intracranial hemorrhages occurred in 4 cases before completion of the induction therapy. Remissions have been maintained for 235 and 172 weeks, respectively, in two cases, while relapse occurred in 23, 29 and 33 weeks in the remaining three cases. Reinduction of remission was attempted by the DNR therapy, but only partial remissions could be attained in two of the three cases.
Controversy over heparin in the induction therapy of APL should be solved further to improve the remission rate, although its use appears to be logical to prevent early death due to hemorrhages. DNR is widely accepted as the drug of first choice in APL in recent years. However, superiority of DNR in combination with other antileukemic agents to DNR alone remained to be clarified not only in the initial induction but also on relapse. Effective maintenance chemotherapy in APL also requires to be established.
