Therapy-related acute leukaemia with mitoxantrone: Four years on, what is the risk and can it be limited?

Ellis, Richard; Brown, Sean; Boggild, Mike

doi:10.1177/1352458514541508

Cited by 22 publications

(13 citation statements)

References 14 publications

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“…Three of our patients developed chronic leukemia and four developed acute myeloid leukemia (0.97% of the whole cohort). The literature mostly mentions MITOX therapy‐related acute myeloid leukemia and the incidence found in our study is within the reported range (0.73–0.9%) . The most recorded malignant entity in our study was breast cancer (incidence 1.7%).…”

Section: Discussionsupporting

confidence: 82%

Clinical follow‐up of 411 patients with relapsing and progressive multiple sclerosis 10 years after discontinuing mitoxantrone treatment: a real‐life cohort study

Chartier

Epstein

Soudant

et al. 2018

Euro J of Neurology

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Section: Discussionsupporting

confidence: 82%

Clinical follow‐up of 411 patients with relapsing and progressive multiple sclerosis 10 years after discontinuing mitoxantrone treatment: a real‐life cohort study

Chartier

Epstein

Soudant

et al. 2018

Euro J of Neurology

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“…Rationale Post approval of mitoxantrone, new evidence has shown a high risk of cardiomyopathy, ovarian failure, male infertility, chromosomal aberrations, and promyelocytic leukemia [34][35][36][37] associated with mitoxantrone use. Other effective medications with lower risk, which were unavailable at the time of US Food and Drug Administration (FDA) approval of mitoxantrone, are now available for treating MS.…”

Section: Starting: Recommendation 13mentioning

confidence: 99%

Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis

et al. 2018

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Objective To develop recommendations for disease-modifying therapy (DMT) for multiple sclerosis (MS).Methods A multidisciplinary panel developed DMT recommendations, integrating findings from a systematic review; followed an Institute of Medicine-compliant process to ensure transparency and patient engagement; and developed modified Delphi consensus-based recommendations concerning starting, switching, and stopping DMTs pertinent to people with relapsingremitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndromes of demyelination. Recommendations were supported by structured rationales, integrating evidence from one or more sources: systematic review, related evidence (evidence not from the systematic review), principles of care, and inference from evidence. ResultsThirty recommendations were developed: 17 on starting DMTs, including recommendations on who should start them; 10 on switching DMTs if breakthrough disease develops; and 3 on stopping DMTs. Recommendations encompassed patient engagement strategies and individualization of treatment, including adherence monitoring and disease comorbidity assessment. The panel also discussed DMT risks, including counseling about progressive multifocal leukoencephalopathy risk in people with MS using natalizumab, fingolimod, rituximab, ocrelizumab, and dimethyl fumarate; and made suggestions for future research to evaluate relative merits of early treatment with higher potency DMTs vs standard stepped-care protocols, DMT comparative effectiveness, optimal switching strategies, long-term effects of DMT use, definitions of highly active MS, and effects of treatment on patient-specified priority outcomes. This guideline reflects the complexity of decisionmaking for starting, switching, or stopping MS DMTs. The field of MS treatment is rapidly changing; the Academy of Neurology development process includes planning for future updates.

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“…Although rare, patients on mitoxantrone may experience promyelocytic disorders such as acute myelogenous leukemia [25]. A detailed literature search by Ellis et al concluded that the risk of leukemia increases significantly once the cumulative exposure exceeds 60 mg/m 2 .…”

Section: Mitoxantronementioning

confidence: 99%

Risk Mitigation Strategies for Adverse Reactions Associated with the Disease-Modifying Drugs in Multiple Sclerosis

Subei

Ontaneda

2015

CNS Drugs

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Over the past several years the number of disease modifying therapies (DMTs) have doubled in number. The thirteen approved agents have shown a wide-range of efficacy and safety in their clinical trials and post-marketing experience. While the availability of the newer agents allows for a wider selection of therapy for clinicians and patients, it requires careful understanding of the benefits and risks of each agent. Several factors such as the medication efficacy, side-effect profile, patient’s preference, and co-morbidities need to be considered. An individualized treatment approach is thus imperative. In this review, risk stratification and mitigation strategies of the various disease modifying agents will be discussed.

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Therapy-related acute leukaemia with mitoxantrone: Four years on, what is the risk and can it be limited?

Cited by 22 publications

References 14 publications

Clinical follow‐up of 411 patients with relapsing and progressive multiple sclerosis 10 years after discontinuing mitoxantrone treatment: a real‐life cohort study

Clinical follow‐up of 411 patients with relapsing and progressive multiple sclerosis 10 years after discontinuing mitoxantrone treatment: a real‐life cohort study

Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis

Risk Mitigation Strategies for Adverse Reactions Associated with the Disease-Modifying Drugs in Multiple Sclerosis

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