Timed sequential chemotherapy with concomitant Granulocyte Colony-Stimulating Factor for high-risk acute myelogenous leukemia: a single arm clinical trialReport as inadecuate




Timed sequential chemotherapy with concomitant Granulocyte Colony-Stimulating Factor for high-risk acute myelogenous leukemia: a single arm clinical trial - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 2:12

First Online: 09 May 2002Received: 22 February 2002Accepted: 09 May 2002DOI: 10.1186-1471-2407-2-12

Cite this article as: He, XY., Elson, P., Pohlman, B. et al. BMC Cancer 2002 2: 12. doi:10.1186-1471-2407-2-12

Abstract

BackgroundThe timed-sequential chemotherapy regimen consisting of etoposide, mitoxantrone and cytarabine EMA is an effective therapy for relapsed or refractory acute myelogenous leukemia AML. We postulated that granulocyte colony-stimulating factor G-CSF might enhance the cytotoxicity of EMA by increasing the proportion of leukemic blasts in S-phase. We added G-CSF to EMA EMA-G for therapy of advanced high-risk AML patients.

MethodsHigh-risk AML was defined as refractory, relapsed or secondary to either an antecedent hematologic disorder or exposure to cytotoxic agents. The patients were treated with one course of EMA-G consisting of mitoxantrone and cytarabine on days 1–3, and etoposide and cytarabine on days 8–10. G-CSF was started on day 4 and continued until absolute neutrophil count recovered.

ResultsThirty patients were enrolled. The median age was 51 years range, 25–75. Seventeen 61% patients had unfavorable cytogenetic karyotypes. Twenty 69% patients had secondary AML. Ten 34% had relapsed disease. Four 14% had refractory AML. Three 10% patients died from febrile neutropenia and sepsis. Major non-hematologic toxicity included hyperbilirubimenia, renal insufficiency, mucositis, diarrhea, nausea and vomiting, skin rash. A complete remission was achieved in 13 46% patients. Median overall survival was 9 months range, 0.5–66. Median relapse-free survival RFS for those who had a CR was 3 months range, 0.5–63 with RFS censored at the time of allogeneic bone marrow transplantation or peripheral stem cell transplantation for 6 of the patients.

ConclusionsEMA-G is a safe and efficacious option for induction chemotherapy in advanced, high-risk AML patients. The activity of EMA may be increased if applied in patients with less advanced disease.

AbbreviationsAMLacute myelogenous leukemia. G-CSF, granulocyte colony-stimulating Factor. GM-CSF, granulocyte-macrophage colony-stimulating Factor. EMA, etoposide, mitoxantrone and cytarabine. EMA-G, EMA and G-CSF.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-2-12 contains supplementary material, which is available to authorized users.





Author: Xing-Yue He - Paul Elson - Brad Pohlman - Alan Lichtin - Mohamad Hussein - Steve Andresen - Matt Kalaycio

Source: https://link.springer.com/







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