Summary
Twenty-two patients with acute myeloid leukemia (AML), having a median age of 48.3 years (range 26–70; 10 male, 12 female), were treated with 4′-(9-acridinylamino)methanesulphon-m-anisidide (m-AMSA) 100 mg/m2 and cytosine arabinoside (AraC) 2×1000 mg/m2 i.v. on days 1–5. There were 2 M1, 8 M2, 9 M4, 2 M4 Eo, and 1 M5a. Of these, 12 achieved a complete remission, 3 a partial remission and 6 did not respond. The median remission duration was 9.0 months and the median overall survival 8.1 months. Side-effects of induction consisted mainly of haematological toxicity and infections with a median duration of WHO-grade-4 granulopenia and thrombopenia of 20 and 28 days respectively. Organ toxicity was mild with mucositis and cutaneous and liver toxicity being experienced by only a few patients. There was one treatment-related death. Five-day m-AMSA and intermediate-dose AraC is an easy-to-handle condensed treatment schedule with tolerable toxicity. Its effectiveness in relapsed and refractory AML is comparable to combinations of high-dose AraC with m-AMSA, anthracyclines or etoposide.
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Abbreviations
- AraC:
-
cytosine arabinoside
- m-AMSA:
-
4′-(9-acridinylamino)methanesulphon-m-anisidide
References
Amadori S, Papa G, Miniero R, Meloni G, Petti MC, Mandelli F (1988) Intermediate-dose ara-C (IdAC) with sequential mitoxantrone (Mitox) in acute myeloid leukemia (AML) (abstract). Proc Am Soc Clin Oncol 7:A670
Arlin ZA, Ahmed T, Mittelman A, Feldman E, Mehta R, Weinstein P, Rieber E, Sullivan P, Baskind P (1987) A new regimen of amsacrine with high-dose cytarabine is safe and effective therapy for acute leukemia. J Clin Oncol 5:371–375
Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnik HR, Sultan C (1985) Proposed revised criteria for the classification of acute myeloid leukemia. A report of the French-American-British cooperative group. Ann Intern Med 103:626–629
Berman E, Arlin ZA, Gaynor J, Miller W, Gee T, Kempin SJ, Mertelsmann R, Andreeff M, Reich L, Nahmias N, et al. (1989) Comparative trial of cytarabine and thioguanine in combination with amsacrine or daunorubicin in patients with untreated acute nonlymphocytic leukemia: results of the L-16M protocol. Leukemia 3:115–121
Breithaupt H, Pralle H, Eckhardt T, von Hattingberg M, Schick J, Loeffler H (1982) Clinical results and pharmacokinetics of high dose cytosine arabinoside (HD ARA-C). Cancer 50:1248–1257
Brito-Babapulle F, Catovsky D, Newland AC, Goldman JM, Galton DAG (1987) Treatment of acute myeloid leukemia with intermediate-dose cytosine arabinoside and mitoxantrone. Semin Oncol 14 [Suppl 1]:51–52
Cheng PN, Leung TW, Shiu WC (1987) Etoposide, high dose ara-C and asparaginase in poor risk acute myeloid leukaemias in Hong Kong (abstract). EORTC Symposium on Recent Advances in Cancer Management 14–15
Decker RW, Ho WG, Champlin RE (1987) Phase II study of amsacrine and high-dose cytarabine for resistant acute myelogenous leukemia. Cancer Treat Rep 71:881–882
Dupont J, Garay G, Scaglione C, Wooley P, Pavlovski S (1981) A phase II trial of m-AMSA in acute leukemia (abstract). Proc Am Assoc Cancer Res Am Soc Clin Oncol 22:477
Early AP, Preisler HD, Slocum H, Rustum YM (1982) A pilot study of high-dose 1-Β-d-arabinofuranosylcytosine for acute leukemia and refractory lymphoma: clinical response and pharmacology. Cancer Res 42:1587–1594
French-American-British (FAB) Co-Operative Group, Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DAG, Gralnick HR, Sultan C (1976) Proposals for the classification of the acute leukaemias. Br J Haematol 33:489–496
Gore M, Powles R, Lakhani A, Milan S, Maitland J, Goss G, Nandi A, Perren T, Forgeson G, Treleaven J, Zuiable A, Porta F (1989) Treatment of relapsed and refractory acute leukaemia with high-dose cytosine arabinoside and etoposide. Cancer Chemother Pharmacol 23:373–376
Gryn J, Conroy J, Crilly P, Topolsky D, Kahn SB, Brodsky I (1989) High-dose cytarabine (HDAC) and VP-16 for refractory or relapsed ANLL (abstract). Proc Am Soc Clin Oncol 8:202
Herzig RH, Wolff SN, Lazarus HM, Phillips GL, Karanes C, Herzig GP (1983) High-dose cytosine arabinoside therapy for refractory leukemia. Blood 62:361–369
Hiddemann W, Kreutzmann H, Straif K, Ludwig WD, Mertelsmann R, Donhuijsen-Ant R, Lengfelder E, Arlin Z, Büchner T (1987) High-dose cytosine arabinoside and mitoxantrone: a highly effective regimen in refractory acute myeloid leukemia. Blood 69:744–749
Hiddemann W, Maschmeier G, Pfreundschuh M, Ludwig WD, Büchner Th (1988) Treatment of refractory acute myeloid (AML) and lymphoblastic leukemia (ALL) with high-dose cytosine arabinoside (Hd Ara-C) and mitoxantrone: indication of increased efficacy by sequential administration (abstract). Proc Am Sco Clin Oncol 7:A731
Hines JD, Oken MM, Mazza JJ, Keller AM, Streeter RR, Glick HJ (1984) High-dose cytosine arabinoside and m-AMSA is effective therapy in relapsed acute non lymphocytic leukemia. J Clin Oncol 2:545
Issell BF (1980) Amsacrine. Cancer Treat Rev 7:73–83
Jehn U, Heinemann V (1990) Intermediate-dose Ara-C/m-AMSA for remission induction and high-dose Ara-C/m-AMSA for intensive consolidation in relapsed and refractory adult acute myelogeneous leukemia. Hamatol Bluttransfus 33:333–338
Kantarjian HM, Estey EH, Plunkett W, Keating M, Walters RS, Iacoboni S, McCredie KB, Freireich EJ (1986) Phase I–II clinical and pharmacologic studies of high-dose cytosine arabinoside in refractory leukemia. Am J Med 81:387–391
Kaplan EL, Meyer P (1958) Nonparametric estimation from incomplete observations. J Am Statist Assoc 53:457–457
Keating MJ, Gehan EA, Smith TL, Estey EH, Walters RS, Kantarjian HM, McCredie KB, Freireich EJ (1987) A strategy for evaluation of new treatments in untreated patients: application to a clinical trial of AMSA for acute leukemia. J Clin Oncol 5:710–721
Lawrence HJ, Ries CA, Reynolds RD, Levis JP, Kroetz MM, Torti FM (1982) AMSA — a promising new agent in refractory acute leukemia. Cancer Treat Rep 66:1475–1478
Legha SS, Keating MJ, Zander AR, McCredie KB, Bodey GP, Freireich FJ (1980) 4′(9-acridinylamino) methanesulfon-m-anisidide: a new drug effective in the treatment of adult acute leukemia. Ann Intern Med 93:17–21
Miller AB, Hoogstraten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214
Ohnuma T, Rosner S, Levy RN, Cuttner Jetal, Moon JH, Silver RT, Blom J, Falkson G, Burningham R, Glidewell O, Holland JF (1971) Treatment of adult leukemia withl-asparaginase. Cancer Chemother Rep 55:269–275
Peters WG, Willemze R, Colly LP (1988) Results of induction and consolidation treatment with intermediate and high-dose cytosine arabinoside and m-Amsa of patients with poor-risk acute myelogenous leukaemia. Eur J Haematol 40:198–204
Plunkett W, Liliemark JO, Adams TM, Nowak B, Estey E, Kantarjian H, Keating MJ (1987a) Saturation of 1-Β-d-arabinofura-nosylcytosine 5′-triphosphate accumulation in leukemia cells during high-dose 1-Β-d-arabinofuranosylcytosine therapy. Cancer Res 47:3005–3011
Plunkett W, Nowak B, Keating MJ (1987b) Effect of amsacrine on ara-CTP cellular pharmacology in human leukemia cells during high-dose cytarabine therapy. Cancer Treat Rep 71:479–483
Rohatiner A, Slevin ML, Dhaliwal HS, Malpas JS, Lister TA (1984) High-dose cytosine arabinoside: response to therapy in acute leukemia and non-Hodgkin's lymphoma. Cancer Chemother Pharmacol 12:90–93
Rudnick SA, Cadman EC, Capizzi RL, Skeel RT, Bertino JR, McIntosh S (1979) High dose cytosine arabinoside in refractory acute leukemia. Cancer 44:1189–1193
Sanz MA, Martinez J, Borrego D, Martin-Aragonés G, Lorenzo I, Sanz G, Sayas MJ, Jarque I, Pastor E, Rafecas J (1987) High-dose cytosine arabinoside and mitoxantrone in high-risk acute nonlymphoblastic leukemia. Semin Oncol 14 [Suppl 1]:18–20
Slevin ML, Shannon MS, Prentice HG, Goldman AJ, Lister TA (1981) A phase I and II study of m-AMSA in acute leukemia. Cancer Chemother Pharmacol 6:137–140
Takaku F, Urabe A, Mizoguchi H, Yamada O, Wakabayashi Y, Miura Y, Sakamoto S, Yoshida M, Miwa S, Asano S, Morisaka T, Nomura T, Toyama K, Aoki I, Murase T, Maekawa T, Miyawaki S, Murakami H, Yamada H, Ohno R, Kawashima K, Yokomaku S, Kinogasa K, Adachi Y, Mori M, Ise T, Mutoh Y, Yamaguchi H (1985) High-dose cytosine arabinoside in refractory acute leukemia. Semin Oncol 12 [Suppl 3]:144–150
Tan CTC, Hancock C, Steinherz PG, Sorell M, Chan KW, Mondora A, Miller DR (1982) Phase II study of 4′(9-acridinylamino)-methanesulfon-m-anisidide (NSC-249992) in children with acute leukemia and lymphoma. Cancer Res 42:1579–1581
Van Echo DA, Markus SD, Schimpff SC, Wiernik PH (1981) A phase II trial of 4′(9-acridinylamino-methanesulfon-m-anisidide in adult relapsed acute leukemia (abstract). Proc Am Assoc Cancer Res Am Soc Clin Oncol 22:230
Van Prooyen HC, Dekker AW, Punt K (1984) The use of intermediate dose cytosine arabinoside in the treatment of acute non-lymphocytic leukemia in relapse. Br J Haematol 57:291–299
Vogler WR, Preisler HD, Winton EF, Gottlieb AJ, Goldberg J, Brennan J, Grunwald H, Rai K, Bowman G, Miller KB, Chervenick P, Azarnia N (1986) Randomized trial of high-dose cytosine arabinoside versus amsacrine in acute myelogenous leukemia in relapse: a Leukemia Intergroup study. Cancer Treat Rep 70:455–459
Walters RS, Kantarjian HM, Keating MJ, Plunkett WK, Estey EH, Andersson B, Beran M, McCredie KB, Freireich EJ (1988) Mitoxantrone and high-dose cytosine arabinoside in refractory acute myelogenous leukemia. Cancer 62:677–682
Willemze R, Fibbe WE, Zwaan FE (1983) Experience with intermediate and high dose cytosine arabinoside in refractory acute leukemia. Onkologie 4:200–204
Willemze R, Jager U, Jehn U, Stryckmans P, Bury J, Suciu S, Solbu G, Zittoun R, Burghouts J, Loewenberg B, Abels J, Cauchie Ch (1988) Intermediate and high dose ara-C and m-AMSA for remission induction and consolidation treatment of patients with acute myeloid leukemia: an EORTC Leukemia Cooperative Group phase II study. Eur J Cancer Clin Oncol 24:1721–1725
Winton EF, Volger WR, Rose KL (1980) Phase II study of acrinidyl anisidide (NSC-249992) in refractory adult acute leukemia (abstract). Proc Am Assoc Cancer Res Am Soc Clin Oncol 21:437
Witz F, Olive D, Lederlin P, Bordigoni P, Troussard X, Grosbois B, Schaison G, Cornu G (1987) IntérÊt des hautes doses de cytosine-arabinoside dans le traitement des leukcémies aiguËs résistantes. Presse Med 16:159–162
Zittoun R, Bury J, Strykmans P, Löwenberg B, Peetermens M, Rozendaal KY, Haanen C, Kerkhofs M, Jehn U, Willemze R (1985) Amsacrine with high-dose cytarabine in acute leukemia. Cancer Treat Rep 69:1447–1448
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Freund, M., Giller, S., Hinrichs, F. et al. Five-day 4′-(9-acridinylamino)methanesulphon-m-anisidide and intermediate-dose cytosine arabinoside in high-risk relapsing or refractory acute myeloid leukemia. J Cancer Res Clin Oncol 117, 489–492 (1991). https://doi.org/10.1007/BF01612772
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DOI: https://doi.org/10.1007/BF01612772