Efficacy and safety of mitoxantrone, etoposide, and cytarabine for treatment of relapsed or refractory acute myeloid leukemia

IF 2.1 4区 医学 Q3 HEMATOLOGY Leukemia research Pub Date : 2024-02-27 DOI:10.1016/j.leukres.2024.107468
Sharon Zhong , Heena Kurish , Robert Walchack , Hong Li , Jessi Edwards , Abhay Singh , Anjali Advani
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Abstract

Background/rationale

Most patients with acute myeloid leukemia (AML) develop relapsed or refractory (R/R) disease after receiving initial induction chemotherapy. Salvage chemotherapy followed by allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only curative therapy for R/R AML. Mitoxantrone, etoposide, and cytarabine (MEC) is the current standard of care salvage regimen for R/R AML at Cleveland Clinic. The primary objective was to determine the overall remission rate (ORR: defined as patients achieving complete remission (CR) or complete remission with incomplete hematologic recovery (CRi)) in R/R AML patients who received MEC.

Methods

Adult patients with R/R AML treated with MEC between July 1, 2014 and September 30, 2022 were included. ORR and its association with baseline characteristics were determined. Secondary outcomes included overall survival (OS), event-free survival (EFS), relapse-free survival (RFS), and safety.

Results

Sixty patients were evaluated. The ORR was 51.7% (33.3% CR and 18.3% CRi). The median time from receipt of MEC to CR/CRi was 7.7 weeks. Patients with bone marrow blasts ≤20% and peripheral blood blasts ≤30% at MEC initiation were more than twice as likely to achieve CR/CRi compared to those with a higher blast burden. The median OS was 6.3 months. Twenty-four (40.0%) patients proceeded to alloHSCT. Twenty-one (35.0%) patients were transferred to the intensive care unit (ICU) during their admission.

Conclusions

MEC is an effective salvage regimen for patients with R/R AML, especially among those with low disease burden at initiation. Febrile neutropenia, infections, and severe oral mucositis were common with MEC administration.

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米托蒽醌、依托泊苷和阿糖胞苷治疗复发性或难治性急性髓性白血病的疗效和安全性
大多数急性髓性白血病(AML)患者在接受初始诱导化疗后,病情会复发或难治。挽救性化疗后进行异基因造血干细胞移植(alloHSCT)是治疗复发或难治性急性髓性白血病的唯一治愈疗法。米托蒽醌、依托泊苷和阿糖胞苷(MEC)是克利夫兰诊所目前治疗R/R AML的标准挽救方案。主要目的是确定接受MEC治疗的R/R急性髓细胞白血病患者的总体缓解率(ORR:定义为达到完全缓解(CR)或完全缓解但血液学未完全恢复(CRi)的患者)。研究纳入了2014年7月1日至2022年9月30日期间接受MEC治疗的R/R AML成人患者。研究确定了ORR及其与基线特征的关系。次要结果包括总生存期(OS)、无事件生存期(EFS)、无复发生存期(RFS)和安全性。共对 60 名患者进行了评估。ORR为51.7%(33.3% CR和18.3% CRi)。从接受 MEC 治疗到 CR/CRi 的中位时间为 7.7 周。开始接受MEC治疗时,骨髓细胞凋亡率≤20%、外周血凋亡率≤30%的患者达到CR/CRi的几率是凋亡率较高患者的两倍多。中位 OS 为 6.3 个月。24例(40.0%)患者进行了异体HSCT。21例(35.0%)患者在入院期间转入重症监护室(ICU)。MEC是治疗R/R急性髓细胞白血病患者的有效挽救方案,尤其是对那些起始时疾病负担较轻的患者。使用MEC时,发热性中性粒细胞减少症、感染和严重的口腔黏膜炎很常见。
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来源期刊
Leukemia research
Leukemia research 医学-血液学
CiteScore
4.00
自引率
3.70%
发文量
259
审稿时长
1 months
期刊介绍: Leukemia Research an international journal which brings comprehensive and current information to all health care professionals involved in basic and applied clinical research in hematological malignancies. The editors encourage the submission of articles relevant to hematological malignancies. The Journal scope includes reporting studies of cellular and molecular biology, genetics, immunology, epidemiology, clinical evaluation, and therapy of these diseases.
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