Recently we experienced a 32 year-old man with chronic myelomonocytic leuekmia who showed an interesting therapeutic response. He was initially treated by oral 6-MP 30∼80 mg daily for 6 months followed by the addition of vincristine, 1.5 mg intravenously every 3 weeks, in order to control white blood cell counts. Mhen the disease became resistent to he combination chemotherapy, he recieved splenic irradiation (400 rad in total), leading to a marked pancytopenia which persisted for 3 weeks. Subsequently he showed leukocytosis due mainly to the increase of monocytoid cells, and hepatosplenomegaly occurred.
VP 16∼213, a semisynthetic podophyllotoxin derivative, 200 mg/day, was orally given for consecutive 5 days every 3∼4 weeks. His hematologic status was markedly improved along with the diminution of hepatosplenomegaly.
Currently he is periodically treated by the combination of VP 16∼213 (100∼200 mg/day for 5 days orally) and cytosine arabinoside (80∼120 mg/day intravenously), resulting in an adeqaute control of both monocytoid and granulocytic cells.
