AAAP Therapy for Relapse of Acute Leukemia

Abstract

A new quadruple combination chemotherapy with ACNU 50mg/day IV (drip over 4 hrs)×4, Adriamycin 30mg/day IV (push)×4, Methotrexate 25mg IV (push) on day 1 and 4, and Prednisolone 60mg/day IV (push)×4 was designed and codenamed AAAP.
Fourteen courses of AAAP were administered in 13 occasions of relapses of 11 acute leukemia cases: all adult patients received intensive maintenance chemotherapy, from 15 to 64 (median 49) year-old at diagnosis; AML, 6 cases, AMoL, 2 cases and ALL, 3 cases. Of 13 relapsed cases, 7 (AML 3, AMoL 1, ALL 3) obtained complete remission (CR), 3 partial remission and 3 failure. In a case of AML (46 year-old), AAAP was indicated for the 3rd relapse resistant to PADOC, then CR was obtained and maintained over 9 mos, which exceeded the initial remission length of 8 mos. In the other case of ALL (62 year-old), AAAP was performed at the 1st relapse, and CR was achieved and maintained for 202 days, which also exceeded the initial remission length of 147 days. Furthermore, in 2 cases (AML, 49 year-old; ALL, 46 year-old), the survival from AAAP exceeded that prior to AAAP.
CR was obtained after only 1 course of AAAP and the median duration to reach CR was 22 days from the beginning of the treatment (20∼33 days). On the other hand, as to hematological changes in CR cases, the median time spent to recover was 32 days in WBC over 3,000/cmm and 27 days in Plt. over 100,000/cmm, from day 1 of AAAP respectively. Thus, myelosuppression was delayed compared to leukemocydal effect in AAAP.