A combination chemotherapy with low doses of cytarabine and etoposide for high risk myelodysplastic syndromes and their leukemic stage. A pilot study.

BACKGROUND. Even now, no definitely effective therapy is inducted to high risk myelodysplastic syndromes (MDS) and their leukemic stage (MDS-AML) except bone marrow transplantation. METHODS, Ten patients with high risk MDS and 6 with MDS-AML were treated with daily low doses of cytarabine (10 mg/m(2)/12h, infused over 2h) etoposide (50 mg/m(2)/day, infused over 2h). RESULTS, Fourteen of these patients were finally evaluated among whom 6 with high risk MDS and 3 with MDS-AML (64.3%) had complete remission, and 2 with high risk MDS (14.3%) achieved partial remission after this chemotherapy for 9 to 21 days. Three of 11 responders were resistant to the prior chemotherapies with single and low dose cytotoxic agents including cytarabine, etoposide, or aclarubicin. Although all of the patients who could be assessed developed severe marrow hypoplasia after chemotherapy, the nonhematologic side effects were mild enough to be tolerated. CONCLUSIONS, Tills combination chemotherapy must be effective and useful in high risk MDS and MDS-AML not only without prior chemotherapy but in cases which have been resistant to single and low dose oncostatic agent. (C) 1996 American Cancer Society.