2013, Number 1
Induction remission chemotherapy 7+3+7E or intermediate-dose cytarabine in adult patients with acute myeloid leukemia: a preliminar report
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ABSTRACTBackground: On previous reports we have informed complete remission (CR) rates in patients with acute myeloid leukemia (AML) treated with chemotherapy 7+3 similar to those reported in the literature. Although incidence of early death during post-chemotherapy bone marrow aplasia is also similar to those reported by other groups, the CR rate after only one 7+3 cycle is considered suboptimal. This could be related to weak chemotherapy regimens or to a biologically more aggressive disease in our patients. Since 2010 we implemented more aggressive chemotherapy regimens in younger patients with AML (≤ 55 years) in order to improve the CR rate.
Methods: In this retrospective study we evaluated a series of adult patients with AML treated at our center between November 2010 and June 2012. The induction regimens used were 7+3+7E which consists of cytarabine given at 100 mg/m2/day, on days 1-7 and daunorubicin given at 45 mg/m2 on days 1-2, plus etoposide 75 mg/m2/day, on days 1-7 of cycle 1; or intermediate-dose cytarabine which consists of cytarabine given at 3 gr/m2/day, on days 1-3 plus daunorubicin given at 45 mg/m2/day, on days 2 and 3 of cycle 1. The goal of this preliminary report was to describe the CR rate and toxicity of the 7+3+7E and intermediate dose cytarabine during induction.
Results: We reported a total of 15 patients, median age of 40 years (range, 19 to 55 years). Analyzable metaphases were obtained in 73.3% (11/15) of the cases, 27.2% (3/11) were classified as having unfavorable cytogenetis, 54.5% (6/11) intermediate and 18.1% (2/11) favorable. Performance status was assessed by the ECOG scoring system, 80% of the patients were classified as ECOG 0-2 and the remaining 20% as ECOG 3-4. Comorbidities were detected in 40% of patients. Primary resistance was found in 6.6% of the patient population. The complete remission rate after the cycle 1 was 66.7%, with an early mortality rate of 13.3%, severe febrile neutropenia was observed in 100% of the patients and septic shock during induction in 6.7%. These results suggest that the use of more intensive induction regimens in younger patients with AML offers higher CR rates compared to our historical cohort of AML patients receiving 7+3 chemotherapy; with acceptable rates of septic shock and early mortality.
Byrd JC, Mrozek K, Dodge RK, et al. Pretreatment cytogenetic abnormalities are predictive of induction success, cumulative incidence of relapse, and overall survival in adult patients with de novo acute myeloid leukemia: results from Cancer and Leukemia Group B (CALGB 8461). Blood 2002;100:4325-4336.
Bradstock KF, Matthews JP, Lowenthal RM, Baxter H, Catalano J, et al A randomized trial of high- versus conventional-dose cytarabine in consolidation chemotherapy for adult de novo acute myeloid leukemia in first remission after induction therapy containing high-dose cytarabine. Blood 2005;105:481-448.