RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Combining more than one drug may kill more tumor cells.
PURPOSE: Phase II trial to study the effectiveness of high-intensity, brief-duration
chemotherapy in treating patients with relapsed or refractory acute lymphocytic leukemia.
OBJECTIVES: I. Determine the complete response rate to high-intensity, brief-duration
chemotherapy with cyclophosphamide, methotrexate, vincristine, doxorubicin, and
dexamethasone followed by ifosfamide, methotrexate, vincristine, cytarabine, etoposide, and
dexamethasone in patients with relapsed or refractory acute lymphocytic leukemia (ALL). II.
Determine the toxic effects of these regimens in these patients.
OUTLINE: All patients receive up to six alternating courses (every 3-4 weeks) of two
chemotherapy regimens: cyclophosphamide, oral dexamethasone, methotrexate with leucovorin
rescue, vincristine, and doxorubicin over 5 days; and ifosfamide/mesna, oral dexamethasone,
methotrexate with leucovorin rescue, vincristine, cytarabine, and etoposide over 5 days.
G-CSF is given following each course until recovery of the neutrophil count. All patients
receive triple intrathecal chemotherapy on day 1. Patients with CNS disease receive
intrathecal therapy twice weekly until the CSF is clear, then weekly for 4 weeks, and
monthly for 1 year; those who have not received prior CNS irradiation also receive
whole-brain radiotherapy. Patients are followed monthly for 6 months, every 3 months for 18
months, every 6 months for 2 years, then annually.
PROJECTED ACCRUAL: A total of 37 evaluable patients will be accrued if at least 4 of the
first 17 patients respond.
DISEASE CHARACTERISTICS: Histologically confirmed acute lymphocytic leukemia that is
relapsed after or refractory to induction therapy 1 or 2 prior inductions allowed, but
refractory to only 1 regimen CNS involvement allowed
PATIENT CHARACTERISTICS: Age: 18 and over Performance status: 0-3 Hematopoietic: Not
specified Hepatic: Bilirubin no greater than 1.5 times normal (unless directly
attributable to leukemia) Renal: Creatinine no greater than 1.5 times normal (unless
directly attributable to leukemia) Cardiovascular: No uncontrolled or severe
cardiovascular disease including: Myocardial infarction within 6 months Congestive heart
failure Other: No uncontrolled duodenal ulcer No uncontrolled infection No second
malignancy within 5 years except curatively treated: In situ cervical cancer Basal cell
skin cancer No other serious medical illness that would limit survival to under 2 years No
psychiatric illness that would prevent informed consent or compliance No pregnant or
nursing women Adequate contraception required of fertile patients
PRIOR CONCURRENT THERAPY: See Disease Characteristics