A multi-institutional comparison of mitoxantrone, etoposide, and cytarabine vs high-dose cytarabine and mitoxantrone therapy for patients with relapsed or refractory acute myeloid leukemia.
A multi-institutional comparison of mitoxantrone, etoposide, and cytarabine vs high-dose cytarabine and mitoxantrone therapy for patients with relapsed or refractory acute myeloid leukemia.
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DOI：
10.1002/ajh.25838
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发表时间：
2020-08
影响因子：
12.8
通讯作者：
Quigley, John G.
中科院分区：
文献类型：
--
作者：
Christian, Sonia;Arain, Saad;Patel, Pritesh;Khan, Irum;Calip, Gregory S.;Agrawal, Vaibhav;Sweiss, Karen;Griffin, Shawn;Cahill, Kirk;Konig, Heiko;Esen, Aysenur;Shergill, Ardaman;Odenike, Olatoyosi;Stock, Wendy;Quigley, John G.
复发性或难治性急性髓性白血病（R/R AML）预后不良，最好采用补救化疗作为异基因干细胞移植（alloSCT）的桥梁。然而，最佳挽救治疗仍不清楚。在这里，我们比较了两种挽救方案：米托蒽醌，依托泊苷，阿糖胞苷（MEC）和米托蒽醌和大剂量阿糖胞苷（阿糖胞苷对）。我们分析了1998年至2017年期间在三个学术机构接受治疗的155名患者; 87名患者接受了MEC，68名患者接受了Ara-C对。主要终点为总体缓解（OR）。次要终点包括无进展生存期（PFS）、总生存期（OS）、住院时间、血液学和非血液学毒性以及成功进行alloSCT。队列的基线特征匹配良好，尽管接受Ara-C偶联的患者有更多的合并症（48.5% vs 33%; P = 0.07）。43.7%的MEC患者和54.4%的Ara-C偶联患者实现了OR（P = 0.10）。Ara-C偶联患者也倾向于更长的OS和PFS，更频繁地进行alloSCT（31% vs 54.4%; P = 0.003），发生较少的发热性中性粒细胞减少症（94% vs 72%; P <0.001）和3/4级胃肠道毒性（17.2% vs 2.94%; P = 0.005）。在其他毒性或中位住院时间方面没有显著差异。这是第一个多机构研究直接比较这些方案在种族多样化的R/R AML患者人群。虽然这些方案在实现OR方面具有等效的疗效，但Ara-C偶联的使用与毒性的显著降低相关，这表明它应该更频繁地用于这些患者。
Relapsed or refractory acute myeloid leukemia (R/R AML) has a poor prognosis and is best treated with salvage chemotherapy as a bridge to allogeneic stem cell transplant (alloSCT). However, the optimal salvage therapy remains unknown. Here we compared two salvage regimens; mitoxantrone, etoposide, and cytarabine (MEC) and mitoxantrone and high-dose Ara-C (Ara-C couplets). We analyzed 155 patients treated at three academic institutions between 1998 and 2017; 87 patients received MEC and 68 received Ara-C couplets. The primary endpoint was overall response (OR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of hospitalization, hematologic and nonhematologic toxicities, and success in proceeding to alloSCT. Baseline characteristics of the cohorts were well matched, though patients receiving Ara-C couplets had more co-morbidities (48.5% vs 33%; P = .07). OR was achieved in 43.7% of MEC and 54.4% of Ara-C couplets patients (P = .10). Ara-C couplets patients also trended towards a longer OS and PFS, more frequently proceeded to alloSCT (31% vs 54.4%; P = .003), and experienced less febrile neutropenia (94% vs 72%; P < .001) and grade 3/4 gastrointestinal toxicities (17.2% vs 2.94%; P = .005). No significant differences in other toxicities or median duration of hospitalization were noted. This is the first multi-institutional study directly comparing these regimens in a racially diverse population of R/R AML patients. Although these regimens have equivalent efficacy in terms of achieving OR, Ara-C couplets use is associated with significant reductions in toxicities, suggesting it should be used more frequently in these patients.
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影响因子：
45.3
作者：
Breems, DA;Van Putten, WLJ;Löwenberg, B
通讯作者：
Löwenberg, B
影响因子：
45.3
作者：
AMADORI, S;ARCESE, W;MANDELLI, F
通讯作者：
MANDELLI, F
影响因子：
2.6
作者：
Larson, Sarah M.;Campbell, Nicholas P.;Stock, Wendy
通讯作者：
Stock, Wendy
影响因子：
1.6
作者：
Xu, Jun;Lv, Ting-Ting;Yuan, Guo-Lin
通讯作者：
Yuan, Guo-Lin
DOI：
10.1016/0021-9681(87)90171-8
发表时间：
1987-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
CHARLSON, ME;POMPEI, P;MACKENZIE, CR
通讯作者：
MACKENZIE, CR