Sequential administration of methotrexate and asparaginase in relapsed or refractory pediatric acute myeloid leukemia

Jassada Buaboonnam, Xueyuan Cao, Jennifer L. Pauley, Ching Hon Pui, Raul C. Ribeiro, Jeffrey E. Rubnitz, Hiroto Inaba

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The efficacy of combination chemotherapy with methotrexate (MTX) and asparaginase is not well known in relapsed and refractory acute leukemia after contemporary therapy. Procedure: A retrospective study of pediatric patients with relapsed or refractory acute myeloid leukemia (AML) who received MTX and asparaginase as a salvage therapy at St. Jude Children Research Hospital was performed. MTX was given intravenously followed by a dose of asparaginase intramuscularly or intravenously 24hours later. The chemotherapy cycle was repeated every 7-10 days. Response, survival, and toxicities were evaluated. Results: Fifteen patients, median age 10.5 years (range, 1.1-18.5 years), were treated. Median number of previous therapeutic regimens was three (range, 1-4). Six patients responded to treatment (three had morphologic complete remission with incomplete blood count recovery, two had partial remission, and one had stable disease for 16 months), and four are still alive. Three of six responders had monoblastic leukemia, and also developed tumor lysis syndrome. The 1- and 2-year overall survival rates are 35.6% and 17.8%, respectively. The most common adverse event was transient elevation of transaminases (nine patients). Two patients developed pancreatitis. Episodes of febrile neutropenia were rare (two patients), and most courses (75 out of 93 total courses) were given in an outpatient setting. Conclusions: Combination chemotherapy with MTX and asparaginase appears to be an effective salvage therapy and well tolerated in patients with relapsed or refractory childhood AML, even in those heavily pretreated with contemporary frontline or salvage therapy.

Original languageEnglish (US)
Pages (from-to)1161-1164
Number of pages4
JournalPediatric Blood and Cancer
Volume60
Issue number7
DOIs
StatePublished - Jul 1 2013

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Asparaginase
Acute Myeloid Leukemia
Methotrexate
Pediatrics
Salvage Therapy
Combination Drug Therapy
Leukemia
Tumor Lysis Syndrome
Febrile Neutropenia
Transaminases
Pancreatitis
Outpatients
Therapeutics
Survival Rate
Retrospective Studies
Drug Therapy
Survival
Research

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Sequential administration of methotrexate and asparaginase in relapsed or refractory pediatric acute myeloid leukemia. / Buaboonnam, Jassada; Cao, Xueyuan; Pauley, Jennifer L.; Pui, Ching Hon; Ribeiro, Raul C.; Rubnitz, Jeffrey E.; Inaba, Hiroto.

In: Pediatric Blood and Cancer, Vol. 60, No. 7, 01.07.2013, p. 1161-1164.

Research output: Contribution to journalArticle

Buaboonnam, Jassada ; Cao, Xueyuan ; Pauley, Jennifer L. ; Pui, Ching Hon ; Ribeiro, Raul C. ; Rubnitz, Jeffrey E. ; Inaba, Hiroto. / Sequential administration of methotrexate and asparaginase in relapsed or refractory pediatric acute myeloid leukemia. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 7. pp. 1161-1164.
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AU - Buaboonnam, Jassada

AU - Cao, Xueyuan

AU - Pauley, Jennifer L.

AU - Pui, Ching Hon

AU - Ribeiro, Raul C.

AU - Rubnitz, Jeffrey E.

AU - Inaba, Hiroto

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N2 - Background: The efficacy of combination chemotherapy with methotrexate (MTX) and asparaginase is not well known in relapsed and refractory acute leukemia after contemporary therapy. Procedure: A retrospective study of pediatric patients with relapsed or refractory acute myeloid leukemia (AML) who received MTX and asparaginase as a salvage therapy at St. Jude Children Research Hospital was performed. MTX was given intravenously followed by a dose of asparaginase intramuscularly or intravenously 24hours later. The chemotherapy cycle was repeated every 7-10 days. Response, survival, and toxicities were evaluated. Results: Fifteen patients, median age 10.5 years (range, 1.1-18.5 years), were treated. Median number of previous therapeutic regimens was three (range, 1-4). Six patients responded to treatment (three had morphologic complete remission with incomplete blood count recovery, two had partial remission, and one had stable disease for 16 months), and four are still alive. Three of six responders had monoblastic leukemia, and also developed tumor lysis syndrome. The 1- and 2-year overall survival rates are 35.6% and 17.8%, respectively. The most common adverse event was transient elevation of transaminases (nine patients). Two patients developed pancreatitis. Episodes of febrile neutropenia were rare (two patients), and most courses (75 out of 93 total courses) were given in an outpatient setting. Conclusions: Combination chemotherapy with MTX and asparaginase appears to be an effective salvage therapy and well tolerated in patients with relapsed or refractory childhood AML, even in those heavily pretreated with contemporary frontline or salvage therapy.

AB - Background: The efficacy of combination chemotherapy with methotrexate (MTX) and asparaginase is not well known in relapsed and refractory acute leukemia after contemporary therapy. Procedure: A retrospective study of pediatric patients with relapsed or refractory acute myeloid leukemia (AML) who received MTX and asparaginase as a salvage therapy at St. Jude Children Research Hospital was performed. MTX was given intravenously followed by a dose of asparaginase intramuscularly or intravenously 24hours later. The chemotherapy cycle was repeated every 7-10 days. Response, survival, and toxicities were evaluated. Results: Fifteen patients, median age 10.5 years (range, 1.1-18.5 years), were treated. Median number of previous therapeutic regimens was three (range, 1-4). Six patients responded to treatment (three had morphologic complete remission with incomplete blood count recovery, two had partial remission, and one had stable disease for 16 months), and four are still alive. Three of six responders had monoblastic leukemia, and also developed tumor lysis syndrome. The 1- and 2-year overall survival rates are 35.6% and 17.8%, respectively. The most common adverse event was transient elevation of transaminases (nine patients). Two patients developed pancreatitis. Episodes of febrile neutropenia were rare (two patients), and most courses (75 out of 93 total courses) were given in an outpatient setting. Conclusions: Combination chemotherapy with MTX and asparaginase appears to be an effective salvage therapy and well tolerated in patients with relapsed or refractory childhood AML, even in those heavily pretreated with contemporary frontline or salvage therapy.

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