Chronic Granulocytic Leukaemia: Multiple-drug Chemotherapy for Acute Transformation

The response to 60 trials of therapy in 50 patients with chronic granulocytic leukaemia (C.G.L.) in acute transformation is reported. None of the 13 patients who received single-agent chemotherapy had a satisfactory response. The use of two drugs in combination produced only one satisfactory respons...

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Bibliographic Details
Published in:BMJ 1974-07, Vol.3 (5923), p.77-80
Main Authors: Spiers, A. D. S., Costello, Christine, Catovsky, D., Galton, D. A. G., Goldman, J. M.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Antineoplastic Agents - adverse effects
Antineoplastic Agents - therapeutic use
Asparaginase - therapeutic use
Blasts
Blood
Blood transfusion
Bone marrow
Chemotherapy
Chromosome Aberrations
Chromosomes, Human, 21-22 and Y
Cyclophosphamide - therapeutic use
Cytarabine - therapeutic use
Daunorubicin - therapeutic use
Drug Therapy, Combination
Female
Humans
Leukemia
Leukemia, Myeloid - drug therapy
Leukemia, Myeloid - genetics
Male
Medical treatment
Metamorphosis
Methotrexate - therapeutic use
Middle Aged
Myeloid leukemia
Papers and Originals
Prednisolone - therapeutic use
Splenectomy
Thioguanine - therapeutic use
Vincristine - therapeutic use
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Summary:The response to 60 trials of therapy in 50 patients with chronic granulocytic leukaemia (C.G.L.) in acute transformation is reported. None of the 13 patients who received single-agent chemotherapy had a satisfactory response. The use of two drugs in combination produced only one satisfactory response in 30 patients. Various types of multiple-drug treatments in eight patients achieved one good response which lasted four months. In contrast when nine patients with rapidly progressive acute transformation of C.G.L. received a regimen—TRAMPCO(L)—incorporating seven or eight drugs (thioguanine, daunorubicin, cytarabine, methotrexate, prednisolone, cyclophosphamide, and vincristine, with or without L-asparaginase colaspase) five improved significantly. Four patients had a good clinical and haematological response with survival for over three, eight, over 12, and 14 and a half months; and one patient had a partial response. Toxicity was not extreme and maintenance therapy with the same regimen was given on an outpatient basis. TRAMPCO(L) seems superior to previously reported regimens and should be considered for rapidly progressive transformation of C.G.L. especially when simpler treatments have failed.
ISSN:0007-1447
0959-8138
1468-5833
DOI:10.1136/bmj.3.5923.77