High dose cytarabine and mitoxantrone: an effective induction regimen for high-risk Acute Myeloid Leukemia (AML)
High dose cytarabine and mitoxantrone: an effective induction regimen for high-risk Acute Myeloid Leukemia (AML)
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DOI：
10.3109/10428194.2011.621562
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发表时间：
2012-03-01
影响因子：
2.6
通讯作者：
Stock, Wendy
中科院分区：
文献类型：
--
作者：
Larson, Sarah M.;Campbell, Nicholas P.;Stock, Wendy
高危AML患者，包括高龄、复发/难治性疾病、不良分子和细胞遗传学异常、治疗相关的髓系肿瘤(t-MN)和多种内科合并症，对标准的阿糖胞苷和柔红霉素诱导治疗反应差，预后差。我们对2001年至2008年在芝加哥大学使用大剂量阿糖胞苷(HiDAC)和米托蒽醌(Mito)替代诱导方案治疗78例高危急性髓细胞白血病患者进行了回顾性分析。研究的主要终点是治疗开始后30天内的完全缓解率(CR)和死亡率。中位年龄为63岁(范围：23-85岁)；27%的患者有Charlson合并症指数(CCI)和GT；2。43例(56%)患者具有不良的细胞遗传学，28例(37%)具有中等风险的细胞遗传学，5例(7%)具有良好的细胞遗传学。CR率为45%，CRI率为10%，术中死亡7例(9%)。值得注意的是，t-MN和复发/难治患者的CR和诱导死亡率与该系列中的初治AML患者相同。在这一高危AML人群中，HiDAC/MITO诱导的总有效率为55%，低诱导死亡率为9%，并允许32名(41%)患者继续进行异基因干细胞移植。
Patients with high-risk AML, defined as those with advanced age, relapsed/refractory disease, unfavorable molecular and cytogenetic abnormalities, therapy-related myeloid neoplasm (t-MN) and multiple medical co-morbidities tend to respond poorly to standard cytarabine and daunorubicin induction therapy and have a poor prognosis. We performed a retrospective analysis of an alternative induction regimen using high dose cytarabine (HiDAC) and mitoxantrone (MITO) administered to 78 high-risk patients with AML at The University of Chicago from 2001 to 2008. The primary endpoints of the study were complete remission (CR) rate and death within 30 days of initiation of treatment. The median age was 63 years (range: 23-85); 27% of these patients had a Charlson co-morbidity index (CCI) > 2. Forty-three (56%) patients had unfavorable cytogenetics, 28 (37%) had intermediate-risk cytogenetics and 5 (7%) had favorable cytogenetics. The CR rate was 45% and the CRi rate 10%; 7 patients (9%) died during induction. Notably, t-MN and relapsed/refractory patients had CR and induction death rates equivalent to de novo AML patients within this series. In this high risk AML population, HiDAC/MITO induction demonstrated an overall response rate of 55% with a low induction death rate of 9% and allowed 32 (41%) patients to proceed to allogeneic stem cell transplant.