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Improved survival in young children with acute granulocytic leukemia treated with combination therapy using cyclophosphamide, oncovin, cytosine arabinoside, and prednisone

Seven of 17 children (41%) under 5 years of age with acute granulocytic leukemia (AGL) treated with either cytosine arabinoside‐cytoxan (CA‐CYT) or Mini‐COAP (CA‐CYT with vincristine sulfate [VCR] and prednisone) have been in continuous complete remission 4 years or more. CA and CYT were each given in the dosage of 120 mg/m2 intravenously, daily in 3 divided doses, for 4 days. Induction consisted of two courses given at intervals of 2 weeks; during maintenance the courses were repeated at intervals of 4 weeks. In the Mini‐COAP regimen, standard 28‐day VCR‐prednisone therapy was superimposed on CA‐CYT induction and 4‐day VCR‐prednisone pulses were superimposed on CA‐CYT maintenance. Transient moderate to severe myelosuppression was frequent; other manifestations of toxicity were mild. Administration of drugs at home was feasible in many instances. Mini‐COAP was proved to be an effective therapeutic regimen for young children with AGL and should be considered as initial therapy.