Five children treated for
acute myeloid leukemia according to the
BFM protocol AML 83 experienced first bone marrow relapse after 7, 10, 14, 18, and 30 months and were retreated for second
remission induction. The
chemotherapy consisted of mAMSA (100 mg/m2 per day i.v., days 1-3),
ARA-C (100 mg/m2, twice daily, days 1-6), and
VP 16 (150 mg/m2 per day, days 4-6). Four of the children achieved a complete second remission after one course of
chemotherapy, and the fifth child died of
pneumonia during bone marrow aplasia. All surviving children received an identical second course within 4-5 weeks, followed by
maintenance chemotherapy. Remission duration was 0, 3, 4, 5, and 5 months. Toxicity was confined to heavy bone marrow depression with
thrombocytopenia (nadir 2-7000, days 7-13) and
leukocytopenia (nadir 0-400, days 8-14).
Bleeding episodes could be prevented by substitution with platelets. Four patients experienced
infections (
pneumonia,
septicemia). We conclude that
combination chemotherapy using mAMSA,
ARA-C, and
VP 16 is effective in inducing a second remission in patients with early bone marrow relapse. The main side effect was considerable bone marrow toxicity.