VP 16-213 and cytosine-arabinoside combination chemotherapy for refractory acute lymphoblastic leukemia in adults

Fifteen adult patients with refractory or relapsing acute lymphoblastic leukemia (ALL) received a 5-day remission induction regimen consisting of VP 16-213 (60 mg/m2 every 12 hr) and cytosine-arabinoside (100 mg/m2 every 12 hr) up to a maximum of three courses. The overall response rate was 60% (915), four patients (27%) achieving CR and five (33%) attaining PR. Responders were maintained with monthly courses of the same combination until progressive disease developed. The median duration of response was 4.5 months (2–12+ months). The regimen was relatively well tolerated. The major toxicity was hematologic. Non-hematologic toxicities included mild nausea and vomiting (1115) and total alopecia (1515). The results obtained with this combination are encouraging, in view of the poor prognosis associated with refractory or relapsing ALL in adults.