Mitoxantrone in the treatment of acute myelogenous leukemia: a review

Abstract

Mitoxantrone is an intravenous anthracenedione structurally related to the anthracycline antibiotics. This drug has been used for several years in the treatment of acute myelogenous leukemia (AML). Its use has been based on its pharmacological properties, its incomplete cross-resistance with other intercalating agents, and its better tolerance as predicted by preclinical studies. Various treatment schedules, using mitoxantrone alone and in combination with other antileukemic agents, have been used in clinical trials. Complete remission (CR) rates ranged from 14 to 44% in refractory AML and from 46 to 79% in relapsed patients. Although a superiority of mitoxantrone over anthracyclines has not been clearly demonstrated in newly diagnosed patients, mitoxantrone is now recognized as a useful drug in first line therapy. The tolerability profile of mitoxantrone indicates that it offers patients an acceptable quality of life compared with standard treatment regimens, and could be a good alternative to the anthracyclines. The development of new therapeutic concepts aiming at an optimization of its use is now in process and first results are promising.

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

“…In a review of mitoxantrone for treating acute myoblastic leukemia, the 4 trials that compared mitoxantrone with daunorubicin in previously untreated adults found no difference in cardiotoxicity. 485 However, a systematic review of 16 studies on the cardiotoxic effects of mitoxantrone on patients <18 years old found the incidence rates of various anthracyclineinduced cardiotoxicities difficult to compare, given methodological differences between studies. 486 Therefore, further randomized studies are required to determine whether mitoxantrone or other anthracycline structural analogs can prevent cardiac damage during therapy.…”

Can Anthracycline Therapy for Pediatric Malignancies Be Less Cardiotoxic?

“…1). It has a large volume of distribution, which allows it to remain in tissues longer [34]. Clinically, mitoxantrone has been used in the treatment of AML, relapsed ALL, and multiple sclerosis.…”

Mito-FLAG as Salvage Therapy for Relapsed and Refractory Acute Myeloid Leukemia

“…Because of these results we modified the FLAGIda protocol by replacing idarubicin with mitoxantrone, as was already described by Clavio et al [15]. On the one side, mitoxantrone is a highly effective agent in the treatment of AML, with CR rates ranging from 14 to 44% in refractory leukemia and from 46 to 79% in relapsed patients [22]. On the other side, synergisms with Ara-C (both as high-dosed bolus and as continuous infusion) or fludarabine have been documented [23][24][25][26].…”