The Treatment of Acute Myelogenous Leukemia in Children and Adults: VAPA Update

  • H. J. Weinstein
  • R. J. Mayer
  • D. S. Rosenthal
  • F. S. Coral
  • B. M. Camitta
  • R. D. Gelber
  • D. G. Nathan
  • E. FreiIII
Part of the Haematology and Blood Transfusion / Hämatologie und Bluttransfusion book series (HAEMATOLOGY, volume 28)

Abstract

Major progress in the treatment of acute myelogenous leukemia (AML) has occurred during the past decade. Advances in chemotherapy and supportive care have been associated with an increase in the complete remission rate of patients under the age of 60 with AML from 35%–55% [5, 7] to approximately 75% [2, 9, 16]. More importantly, the median duration of complete remission and the percentage of patients in long-term continuous complete remission has steadily improved. This has resulted from postinduction combination chemotherapy [10, 13, 18, 20] or chemoradiotherapy and transplantation of marrow from histocompatible siblings [4, 15, 21]. In 1976 the VAPA protocol was initiated to specifically improve the duration of complete remission for children and adults (< 50 years) with AML. In 1980 we reported encouraging results obtained with this approach [12, 22], and this report is an update of the study.

Keywords

Leukemia Oncol Sine Prednisone Prednisolone 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Armitage JD, Burns CP (1976) Maintenance of remission in adult acute non-lymphoblastic leukemia using intermittent courses of cytosine arabinoside (NSC-63878) and 6-thioguanine (NSC-752). Cancer Treat Rep 60:585–589PubMedGoogle Scholar
  2. 2.
    Baehner RL, Bernstein ID, Sather H, Higgins G, McCreadie S, Chard RL, Hammond D (1979) Improved remission induction rate with D-ZAPO but unimproved remission duration with addition of immunotherapy to chemotherapy in previously untreated children with ANLL. Med Pediatr Oncol 7: 127PubMedCrossRefGoogle Scholar
  3. 3.
    Bell R, Rohatiner AZS, Slevin ML, Ford JM, Dhaliwal HS, Henry G, Birkhead BG, Amess JAL, Malpas JS, Lister TA (1982) Short-term treatment of acute myelogenous leukemia. Br Med J 284: 1221–1224CrossRefGoogle Scholar
  4. 4.
    Blume G, Spruce WE, Forman SJ, Wolf JL, Farbstein MJ et al. (1981) Bone marrow transplantation for acute leukemia. N Engl J Med 305: 101–103PubMedGoogle Scholar
  5. 5.
    Carey RW, Ribas-Mundo M, Ellison RR, Glidewell O, Lee ST, Cuttner J et al. (1975) Comparative study of cytosine arabinoside therapy alone and combined with thioguanine, mercaptopurine, or daunorubicin in acute myelocytic leukemia. Cancer 36: 1560–1566PubMedCrossRefGoogle Scholar
  6. 6.
    Chard RL, Finkelstein JZ, Sonlez MJ, Nesbit M, McCreadie S, Weiner J, Sather H, Hammond D (1978) Increased survival in childhood acute non-lymphocytic leukemia after treatment with prednisone, cytosine arabinoside, 6-thioguanine, cyclophosphamide, and oncovin (PATCO) combination chemotherapy. Med Pediatr Oncol 4:263–273PubMedCrossRefGoogle Scholar
  7. 7.
    Clarkson BD, Dowling MO, Gee TS, Cunningham IB, Burchenal JH (1975) Treatment of acute leukemia in adults. Cancer 36:775–795PubMedCrossRefGoogle Scholar
  8. 8.
    Dahl GV, Simone JV, Hustu HO, Mason C (1978) Preventive central nervous system irradiation in children with acute non-lymphocytic leukemia. Cancer 42:2187PubMedCrossRefGoogle Scholar
  9. 9.
    Gale RPL (1979) Advances in the treatment of acute myelogenous leukemia. N Engl J Med 300: 1189–1199PubMedCrossRefGoogle Scholar
  10. 10.
    Gale RP, Foon KA, Cline MJ, Zighelboim J et al. (1981) Intensive chemotherapy for acute myelogenous leukemia. Ann Intern Med 94:753–757PubMedGoogle Scholar
  11. 11.
    Lister T A, Whitehouse JMA, Oliver TRD, Bell R, Johnson SA, et al. (1980) Chemotherapy and immunotherapy for acute myelogenous leukemia. Cancer 46:2142–2148PubMedCrossRefGoogle Scholar
  12. 12.
    Mayer RJ, Weinstein HJ, Rosenthal DS, Coral, FS, Nathan DG, Frei E III (1981) VAPA 10: a treatment program for acute myelocytic leukemia. In: Neth R, Gallo RC, Graf T, Mannweiler K, Winkler K (eds) Modern Trends in Human Leukemia IV. Springer, Berlin Heidelberg New York (Haematology and Blood transfusion, vol 26)Google Scholar
  13. 13.
    Peterson BA, Bloomfield CD (1981) Long-term disease-free survival in acute non-lymphocytic leukemia. Blood 57: 1144–1147PubMedGoogle Scholar
  14. 14.
    Peto R, Pike MC, Armitage P et al. (1977) Design and analysis of randomized clinical trails requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35: 1–39PubMedCrossRefGoogle Scholar
  15. 15.
    Powles RL, Morgenstern G, Clini HM, Hedley D, Bandine G et al. (1980) The place of bone marrow transplantation in acute myelogenous leukemia. Lancet I: 1047–1050CrossRefGoogle Scholar
  16. 16.
    Preisler HD, Rustum Y, Henderson ES, Bjornsson S et al. (1979) Treatment of acute non-lymphocytic leukemia: Use of anthracycline-cytosine arabinoside induction therapy and a comparison of two maintenance regimens. Blood 53:455–464PubMedGoogle Scholar
  17. 17.
    Preisler H, Browman G, Henderson ES (1980) Treatment of acute myelocytic leukemia: Effects of early intensive consolidation. Proc Am Assoc Clin Oncol Abstract C-493Google Scholar
  18. 18.
    Rai KR, Holland JF, Glidewell OJ, Weinberg V, Brunner K et al. (1981) Treatment of acute myelocytic leukemia: A study by Cancer and Leukemia Group B. Blood 58: 1203–1212PubMedGoogle Scholar
  19. 19.
    Skipper HE (1978) Reasons for success and failure in treatment of murine leukemias with drugs now employed in treating human leukemias. In: Cancer chemotherapy, vol I. University Microfilms International. Southern Research InstituteGoogle Scholar
  20. 20.
    Spiers ASD, Goldman JM, Catowsky D, Costallo C, Galton DAG, Pitcher CS (1977) Prolonged remission maintenance in acute myeloid leukemia. Br Med J 2: 544–547PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas ED, Buckner CD, Clift RA, Fefer A, Johnson FL (1979) Marrow transplantation for acute non-lymphoblastic leukemia in first remission. N Engl J Med 301:597–599PubMedCrossRefGoogle Scholar
  22. 22.
    Weinstein HJ, Mayer RJ, Rosenthal DS, Camitta BM, Coral FS, Nathan DG, Frei E III (1980) Treatment of acute myelogenous leukemia in children and adults. N Engl J Med 303:473–478PubMedCrossRefGoogle Scholar
  23. 23.
    Weinstein, HJ, Griffin TW, Feeney J, Cohen HJ et al. (1982) Pharmacokinetics of continuous intravenous and subcutaneous infusions of cytosine arabinoside. Blood 59: 1351–1353PubMedGoogle Scholar
  24. 24.
    Wiernik PH, Schimpff SC, Schiffer CA, Lichtenfeld JL, Aisner J et al. (1976) Randomized clinical comparison of daunorubicin alone with a combination of daunorubicin, cytosine arabinoside, 6-thioguanine, and pyrimethamine for the treatment of acute non-lymphocytic leukemia. Cancer Treat Rep 60:41–53PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1983

Authors and Affiliations

  • H. J. Weinstein
  • R. J. Mayer
  • D. S. Rosenthal
  • F. S. Coral
  • B. M. Camitta
  • R. D. Gelber
  • D. G. Nathan
  • E. FreiIII

There are no affiliations available

Personalised recommendations