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Am J Hematol. 2019 Feb;94(2):209-215. doi: 10.1002/ajh.25347. Epub 2018 Dec 5.

Elderly do benefit from induction chemotherapy: High dose mitoxantrone-based ("5 + 1") induction chemotherapy regimen in newly diagnosed acute myeloid leukemia.

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Division of Bone Marrow Transplantation, UMass Memorial Medical Center, Worcester, Massachusetts.
Department of Stem Cell Transplant and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas.
Department of Internal Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
Albany Medical College, New York.
Lahey Cancer Center and Clinic, Massachusetts.
UMass Memorial Medical Center Cytogenetics Director, Quest Diagnostics.
Banner MD Anderson Cancer Center, Phoenix, Gilbert, Arizona.


An intensive "5 + 1" regimen, which included bolus high dose cytarabine (HiDAC) at 3 g/m2 once daily over 3 hours on days 1-5 and high dose mitoxantrone (HDM) 80 mg/m2 on day 2, was evaluated in 101 consecutively treated newly diagnosed acute myeloid leukemia (AML) patients at a single center since 2009. The median age was 65 (range 18-90) years. The 4 and 8-week mortality in our cohort was 3/101 (2.9%) and 7/99 (7%), respectively. The overall response (complete remission [CR] + CRi) was 76.2% (77/101). The median overall survival (OS) stratified by age group <60, 60-69 and ≥70 years were 56, 31 and 9 months respectively (log-rank, P = 0.02). 51.7% (45/84) of patients with intermediate/adverse risk category proceeded to allogeneic stem cell transplants. Among these 84 patients, the percentage of patients able to proceed to transplant in age groups <60, 60-69, and ≥ 70 years were 75% (18/24), 60.7% (17/28), and 31.2% (10/32), respectively. In conclusion, HDM-based chemotherapy regimen produces high CR rates, is well tolerated and more patients can undergo curative postremission therapy including stem cell transplant.


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