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Mitomycin C in the Treatment of Chronic Myelogenous Leukemia

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Mitomycin C in the Treatment of Chronic Myelogenous Leukemia Nagoya ]. med. Sci. 29: 317-344, 1967. MITOMYCIN C IN THE TREATMENT OF CHRONIC MYELOGENOUS LEUKEMIA AKIRA HosHINo 1st Department of Internal Medicine Nagoya University School oj Medicine (Director: Prof. Susumu Hibino) SUMMARY Studies made of the treatment with 66 courses of mitomycin C in 28 patients with chronic myelogenous leukemia are reported. The effect of mitomycin C was investigated according to the relation between drug and host factors, comparison with the effects of other agents, and drug resistance. Patients with less hematological and clinical symptoms responded better to mitomycin C therapy. The remission rate of cases treated intravenously with mitomycin C was 93.8% and of cases treated orally with mitomycin C was 72.0%. The remission rate of the total cases (intravenous and oral) treated with mitomycin C was 77.3%. The therapeutic effect of mitomycin C is considered to be equal or be somewhat superior to the effect of busulfan as a result of data on the occurrence of resistance, cross resistance, development of acute blastic crisis and life span. Busulfan was effective in patients resistant to mitomycin C, and mitomycin C did not clinically show cross resistance to alkylating agents. Two patients resist· ant to mitomycin C recovered the sensitivity to mitomycin C after treatment with busulfan or 6-mercaptopurine. Side effects were observed in 39.4% of 66 cases, but severe side effect causing suspension of mitomycin C was rare. I. INTRODUCTION Human leukemia serves as a useful investigative model in which the de­ finite effect of anti-cancer agents can be evaluated quantitatively by factors such as the improvement of hematological findings and clinical symptoms, the remission rate, and the prologation of life span. In chronic myelogenous leukemia the alkylating agents, busulfan11 - 15 >, TEM 15>- 23>, thio-TEPA12 )15>2"-27 >, nitromin15 >23 >281 - 31 >, have been used for treatment of the disease. 6-mercaptopurine, one of the anti-metabolites, has also been found effective321 - 351 • £ !l!f J'il': Received for publication Oct 17, 1966. Present Address: Aichi Cancer Center, Research Institute, Nagoya. 317 318 A. HOSHINO Recently, following the discovery of mitomycin C36 )-33 ), this new antibiotic has been tried for the treatment of chronic myelogenous leukemia, and the 43 effects of the drug have been reported by Kimura39 )40J, Hibino41 J42 ), Kurita «J, 47 Ota'5l, Yamada46 l, and this author J~sJ_ The patients with chronic myelogenous leukemia were treated at the First Department of Internal Medicine of the Na- goya University School of Medicine over the past 10 years. Among them, 28 patients (total 66 cases of treatment courses) have been under mitomycin C therapy, This paper deals with the analysis of hematological and clinical findings in relation to the effect of mitomycin C, and comparison of the effect of mi­ tomycin C with other agents as regards the remission rate, duration of remis­ sion, and life span. The occurrence of acute blastic crisis, the emergence of the clinical resistance to mitomycin C, and the cross resistance to other drugs, which alters greatly the prognosis of the patients, have also been studied. II. MATERIALS AND METHODS Mitomycin C was obtained from Kyowa Hakko Co. Ltd. An ampule with 2 mg of mitomycin C was dissolved in 20 ml of 5% glucose or in 20 ml of physiological saline. The initial dosage of 1-2 mg was injected intravenously once a day. In case of oral use, 5-6 mg tablets were administered one to three times daily. When the decrease of white blood cell count could not be observed after 2 weeks of initial therapy, the subsequent oral dosage was increased to 9 mg a day. The evaluation of the response of the patients to the drug was carried out by a scoring system following Kimura's criteria (Table 1)~ 0 J 49 l 50 l . Patients obtained points of 40 or more were classified as remission case (complete remission, 60 points or more; partial remission, 59-40 points), and less than 39 points were evaluated as cases of failure of the treatment. The clinical and hematological data prior to the first course of mitomycin Abbreviation of agents Busulfan Myleran, Dimethane sulphonyloxybutane Endoxan Cytoxan, Cyclophosphamide Nitromin Nitrogen mustard N-oxide 6MP 6-mercaptopurine RC-4 P-phenylenediphosphoric acid tetraethy leneimide AL-NM Alanine nitrogen mustard MMC Mitomycin C TEM Triethylene melamine Thio-TEPA Triethylene thiophosphoramide Trenimon Triethylene benzoquinone N. M. Nitrogen mustard TABLE 1. Criteria for Evalution of Response to Chemotherapy in Chronic Leukemia Grade I Score I Grade II Score I Grade III I Score -· 1. Immature cells decrease 1. Immature cells decrease I and leukopoiesis becomes 10 I 5 No improvement ~ · A. normal I or improvement Bone I 0 less than ~ marrow I II 0 2. Erythropoiesis increases 2. Erythropoiesis increases, 5 A-Grade to more than 20% 10 but less than20% ~ ><: I () decrease. but not to z 1. WBC decrease to less 20 1. WBC 10 () than 15,000 less than 15,000 g 2. Immature cells disappear 2. Immature cells decrease t:rJ or decrease to less than 10 to less than 20% 5 No improvement >d B. 10% > I or improvement 0 '1:1 Peripheral less than ><: Hgb contents increase to blood 3. Hgb contents increase to 10 3. 5 B-Grade II 0 more than 80% more than 60% "%j () 4. Platelet counts do not 4. Platelet counts do not ~ decrease to less than 10 decrease to less than 5 ::tl 150,000 80,000 0z c=i SpleP.n decreases, but not I t-' Splenomegaly disappears No improvement t:rJ size, c. or decreases to less than I to less than 1/3 in c::: or improvement 0 Physical 1/3 in size, marked deere- 20 significant reduction of 10 less than ::-1 findings ase of hepatomegaly and hepatomegaly and lymph- C-Grade II t:rJ lymphadenopathy adenopathy >~ No improvement D. Asymptomatic, or marked Definite improvement, or improvement Clinical improvement of leukemic 10 though still symptomatic 5 less than 0 findings symptoms D-Grade II Complete remission: over 60 points :.> .., Partial remission: from 40 to 59 points - TABLE 2. Clinical and Hematological Findings, and Effects of Mitomycin C in the Patients with Chronic Myelogenous Leukemia ~ Clinical and Hematological Findings Before MMC Therapy Effect of Mitomycin C Therapy tj ::r: !>) td <1> ~... ~ I <1> El ~ '0 ~- ~ ... ~ ... ~tj Ul !':! El ~-~ ~g~ SUJ !>) ~~ ...... ro r-+ C'tl ro r-+ ('1) t1> Case Age Sex Ol(bo" <1>'0 ::1'< '< so.otjgO,otj El !':! t:x:l o-liO! WBC Hgb oq(; ...0 l:ll PL I g~ !:9-g.g ::! ~ 0 3 t:1 w' O<l E.o ~·oq E.~» ~-o ~ ~·'"' 1>'::> <1> '< !':! 0 .., 0 ~o El '0'0 () El ~- ~~r~~ ~-~~ <1> <1> ~ ~.<·~g; . < ;~ 8.~ ~ '<• oq ~::r ... ::r· <1> g<~>o.lo'<~>o. o g e:. I e:. '< ::> ::> I I % x10' I % -% % '< (rug) I (rug) (month) ** (month) I. G. 38 M 84,600 91 18.6 6.5 0 0.2 - I + - 2-3 37 15 0.5 I PR 46 A.W. 61 F 72,600 65 25.5 0 0 - - 1 26 26 6 CR 62 K.A. 49 F 72.800 79 10.0 0 0 * - - 0.5-1 28 28 5 CR 24 T . N. 22 M 110,600 85 14.0 23.0 0 0.4 *+ - - 0.5-2 71 39 8 CR 49 T. I. 34 M 95,400 97 10.3 26.0 0 2.2 + - - 1 13 13 5 CR 69 K.T. 28 M 31,400 68 19.5 66 .0 5.5 6.6 - 1-2 - - - NE 23 K.O. 34 F 265,800 78 16.3 19.5 0 * *- - 1 70 70 3 CR 46 ?> 30 F 153,200 54 28.2 28.0 0 0.9 - 1-2 ::r: s.s. * + 61 61 14 CR 56 0 K.M. 24 M 90,600 87 42.0 0 0 *+ - - 5* 70 14 1.5 CR 56 K.W. 36 F 77,400 51 - - 5* - - - NE 46 ~ -- - I - K.S . 34 M 70,000 76 28.4 0 * 5* - - NE 43 z0 M.K. 44 54,000 21.0 0 - F 62 I 49.8 * 5* 85 17 7.5 CR 19 T.S. 34 M 66,800 60 56.8 25.5 0.5 3.4 *+ I *+ + 5* 70 14 2.5 CR 17t Y.K. 30 F 144,0001 49 . 5.8 18.0 0.5 2.2 + 5* - - - NE 3 G.N. 55 M 299,200; 53 21.8 38.0 1.0 2.4 * *+ - 5* 105 38 3 I CR 18 M.T. 19 F 185,000 57 152.5 27.5 0 1.3 * - 5* 75 I 15 11 CR 44t s .s. 19 M 380.000 65 14.1 25.5 1.0 1.2 * * - 5* 220 44 2 CR 42t Z . Y. 67 M 199,600 25 10.3 1.0 *- *+ - 5* 210 42 13 CR 23 T.O. 23 M 313,700 56 29.7 36.5 0.5 1.6 + 5* - - - NE 30t s.o. 46 M 70,600 80 19.6 36.5 0.5 * *- - 5-7.5* 450 86 9.5 CR 37t K.O. 38 M 42,800 1 85 82.5 19.0 0.5 1.6 *- -- 4* 16 4 0.5 CR 12 s.s. 47 M 46,000 80 91.7 39.0 2.0 0.4 + - 4-6* 168 28 3 CR 23t F. I. 36 F 353.000 64 40.8 58.5 3.0 0 *+ - 6* - - - NE 1St T . S. 22 M 553,000 46 33.5 60.0 3.0 3.2 * 6-9* - - - NE 22t T.M.
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