High-dose methotrexate for the remission induction of refractory adult acute lymphocytic leukemia.

Six adults with refractory acute lymphocytic leukemia (ALL) were treated with high-dose methotrexate, citrovorum factor, and vincristine. All patients had previously received extensive treatment with standard therapeutic agents, including vincristine, and all but one had received prior methotrexate. Two patients achieved complete remission and one achieved partial remission. Responses were seen at 3--6 gm/m2 of methotrexate. The durations of remission were 7--10 weeks. High-dose methotrexate with citrovorum factor is effective in the treatment of advanced ALL and should be considered for inclusion in initial combination chemotherapeutic regimens for adult ALL.