Postremission High Dose Cytarabine
Cytarabine 3 g per square meter 3-hour infusion every 12 hours (twice daily) on days 1, 3, and 5 for a total of six doses per course
Sequential courses no sooner than every 28 days or 1 week after marrow recovery (more than 1500 granulocytes per cubic millimeter and more than 100,000 platelets per cubic millimeter)
Repeat for 4 courses in total
Patients in the CALGB Trial with t(8;21) disease had a particularly favourable outcome if given three or more courses of high dose Ara-C rather than one.
note:The protocol attempted to deliver four courses at the dose level allocated, but in practice only 56% received all four courses of the 3 g dose. Apart from compliance problems, dose escalation can be associated with extra toxicity, in particular cerebellar toxicity which appears to correlate with the patient's age, renal function and total dose given. In the CALGB study the toxicity in patients over 60 years became prohibitive.
John C. Byrd et al, Patients With t(8;21)(q22;q22) and Acute Myeloid Leukemia Have Superior Failure-Free and Overall Survival When Repetitive Cycles of High-Dose Cytarabine Are Administered Journal of Clinical Oncology, Vol 17, Issue 12 (December), 1999: 3767-3775