Combination chemotherapy of carboplatin and cytosine arabinoside for high-risk leukemia: a pilot study

Recovery of normal hemopoiesis in disseminated cancer therapy--a model

The strategy of normal cell regeneration with recombinant hematopoietic growth factors during cancer chemotherapy is investigated by superimposing a treatment protocol on a simple model that describes an expanding malignant cell population that is coexisting with and inhibiting the population of normal cells. The model predictions suggest that the strategy of normal cell stimulation, possibly with growth factors, and possibly carried out within an intensive treatment framework may be a worthwhile chemotherapeutic option. Under this protocol, the model also predicts a minimum time interval for active treatment, a time to discontinue treatment, and a rest period during treatment in order to guarantee patient safety and recovery. Consequently, by relating and comparing model predictions to patient data, model simulations forecast that treatment could be shortened by 1-2 weeks if organized over or in the neighborhood of a predicted optimal time interval. Following this, it is conjectured that such an approach engendered by the model could produce outcomes that may have an edge over outcomes arising from therapeutic strategies that are executed over time frames that are relatively longer or significantly shorter than the predicted optimal time.

Continuous-infusion carboplatin in combination with idarubicin or mitoxantrone for high-risk acute myeloid leukemia: a randomised phase II study

Fifty-three patients of median age 66 years (39 patients > 60 yrs), including 5 with FAB unclassified or secondary acute myeloid leukemia (AML) at diagnosis, 14 with resistant AML, 19 in first and 15 in subsequent relapse, were treated with carboplatin (CBP), 200 mg/m2/day, as a continuous infusion, (days 3 to 7) with mitoxantrone (MIT) or idarubicin (IDA), (12 mg/m2/day) as an i.v. bolus, on days 1 to 3. Results were evaluated after one induction course. Overall, 15 patients (28% [95% confidence interval (CI), 17-42%], 8/28 with IDA and 7/25 with MIT) achieved complete remission (CR). There was no statistical difference between IDA and MIT arms. Fourty-nine percent (95% CI, 35-63%) had resistant disease (53% IDA versus 44% MIT respectively) and 23% (95% CI, 12-36%) died from toxicity (18% IDA versus 28% MIT). Median durations of neutrophils less than 0.5 x 10(9)/l and platelet counts less than 20 x 10(9)/l were 32 and 32 days respectively in the IDA arm and 31 and 26 days respectively in the MIT arm. Severe toxicity included infections (45%), diarrhea (21%), bleeding (9%), vomiting (7%), hyperbilirubinemia (6%), mucositis (4%) (no statistical difference was seen between both arms). Nephrotoxicity was observed in only one case in the IDA arm. Cardiac toxicity included reversible pulmonary oedema in one patient in the IDA arm. No severe ototoxicity was noted. CR patients received maintenance courses with 3 days of CBP and one day of IDA or MIT. Median survival was 2 months (range, 1-30+ months) and 2.5 months (range, 0.5-19.5 months), and median disease-free survival (DFS) 2 months (range, 1-30+ months) and 2.5 months (range, 1-14 months) in the IDA and MIT arms respectively. We conclude that CBP at a cumulative dosage of 1 g/m2 together with intercalating agents (IDA/MIT) has antileukemic efficacy in elderly patients.