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Leuk Res. 2013 Nov;37(11):1502-8. doi: 10.1016/j.leukres.2013.09.003. Epub 2013 Sep 8.

A phase I study using bortezomib with weekly idarubicin for treatment of elderly patients with acute myeloid leukemia.

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Markey Cancer Center, University of Kentucky, Lexington, KY, United States. Electronic address:


We report the results of a phase I study with four dose levels of bortezomib in combination with idarubicin. Eligible patients were newly diagnosed with acute myeloid leukemia (AML) age ≥60 years, or any adult with relapsed AML. Bortezomib was given twice weekly at 0.8, 1.0, or 1.2 mg/m(2) with once weekly idarubicin 10 mg/m(2) for four weeks. Twenty patients were treated: 13 newly diagnosed (median age 68, range 61-83) and 7 relapsed (median age 58, range 40-77). Prior myelodysplastic syndrome (MDS) was documented in 10/13 (77%) newly diagnosed and 1/7 (14%) relapsed patients; the three newly diagnosed patients without prior MDS had dyspoietic morphology. Two dose-limiting toxicities occurred at the initial dose level (bortezomib 0.8 mg/m(2) and idarubicin 10 mg/m(2)); idarubicin was reduced to 8 mg/m(2) without observing subsequent dose-limiting toxicities. The maximum tolerated dose in this study was bortezomib 1.2 mg/m(2) and idarubicin 8 mg/m(2). Common adverse events included: neutropenic fever, infections, constitutional symptoms, and gastrointestinal symptoms. No subjects experienced neurotoxicity. Most patients demonstrated hematologic response as evidenced by decreased circulating blasts. Four patients (20%) achieved complete remission. There was one treatment-related death. The combination of bortezomib and idarubicin in this mostly poor-risk, older AML group was well tolerated and did not result in high mortality. This trial was registered at as #NCT00382954.


AML; Acute myeloid leukemia; Bortezomib; DLT; DSMC; Data Safety Monitoring Committee; EMSA; Elderly; FACS; Idarubicin; LSC; MDS; MTD; NF-kB; acute myeloid leukemia; dose-limiting toxicity; electrophoretic mobility shift assay; fluorescence-activated cell sorting; iKBa; inhibitor of NF-kB; leukemic stem cell; maximum tolerated dose; myelodysplastic syndrome; nuclear factor kappa B

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