Induction of remission with l-asparaginase, cyclophosphamide, cytosine arabinoside, and prednisolone in adult patients with acute leukemia

Seventy-one adults with acute leukemia were randomized for treatment with a combination of cyclophosphamide, cytosine arabinoside, and prednisolone, with (CAPA) or without (CAP) the addition of L-asparaginase. Remissions were induced with CAPA in 9 patients (33%) with AML, and 8 patients (67%) with ALL, and with CAP in 10 patients (40%) with AML, and 4 patients (57%) with ALL. Thus, the addition of L-asparaginase did not improve the response significantly. The over-all complete remission rate was significantly higher in females (45%) than in males (23%), and the rate below 50 years of age tended to be higher (45%) than above this age (27%). There was a slight tendency for a longer first remission time in AML with L-asparaginase (284 days) than without (74 days), but no such difference between the two ALL groups. Hyper-sensitivity reactions, nausea, vomiting, psychiatric disturbances, and liver dys-function were more common side effects in patients treated with L-asparaginase.