Sequential induction chemotherapy with vincristine, daunorubicin, cyclophosphamide, and prednisone in adult acute lymphoblastic leukemia

• Published in: Annals of hematology 1995-02, Vol.70 (2), p.65-69
• Main Authors: THOMAS, X, DANAÏLA, C, SEBBAN, C, ARCHIMBAUD, E, FIERE, D, BACH, Q. K, DUFOUR, P, CHRISTIAN, B, CORRONT, B, BOSLY, A, BASTION, Y, GRATECOS, N, LEBLAY, R
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - standards; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Confidence Intervals; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - standards; Daunorubicin - administration & dosage; Daunorubicin - adverse effects; Daunorubicin - standards; Female; Humans; Hyperbilirubinemia - chemically induced; Male; Medical sciences; Middle Aged; Nausea - chemically induced; Pharmacology. Drug treatments; Pilot Projects; Precursor Cell Lymphoblastic Leukemia-Lymphoma - blood; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Prednisone - administration & dosage; Prednisone - adverse effects; Prednisone - standards; Remission Induction; Salvage Therapy; Vincristine - administration & dosage; Vincristine - adverse effects; Vincristine - standards
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/BF01834381

Sequential chemotherapy with vincristine, daunorubicin, cyclophosphamide, and prednisone doses was administered to 57 adult patients with acute lymphoblastic leukemia (ALL). Complete remission (CR) was achieved in 51 (89%, 95% confidence intervals, [CI] 78-96%). Among patients achieving CR, 62% were in CR after one sequence of chemotherapy, 23% after two sequences, and 5% after three sequences. Six patients (11%) had resistant disease. All patients experienced profound myelosuppression. Median time to recovery of neutrophils > 0.5 x 10(9)/1 was 22 days (range: 5-89 days), and of platelets > 100 x 10(9)/1 21 days (range: 0-45 days). Nonhematologic WHO grade 3 or more side effects consisted predominantly of hyperbilirubinemia (7%), mucositis (5%), nausea and vomiting (2%), and cutaneous toxicity (1%). Severe infectious complications occurred in only 14% of cases. One patient (2%, 95% CI 0-9%) died of therapy-related toxicity while in early CR. We concluded that sequential use of prednisone seemed at least as effective as continuous administration at the expense of a few adverse side effects.