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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.

Author information

1
Division of Bone Marrow Transplantation, UMass Memorial Medical Center, Worcester, Massachusetts.
2
Department of Stem Cell Transplant and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas.
3
Department of Internal Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
4
Albany Medical College, New York.
5
Lahey Cancer Center and Clinic, Massachusetts.
6
UMass Memorial Medical Center Cytogenetics Director, Quest Diagnostics.
7
Banner MD Anderson Cancer Center, Phoenix, Gilbert, Arizona.

Abstract

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.

PMID:
30417942
DOI:
10.1002/ajh.25347

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