Timed Sequential Salvage Chemotherapy for Relapsed or Refractory Acute Myeloid Leukemia

Abstract

A B S T R A C TTherapy for those with relapsed or refractory acute myeloid leukemia is suboptimal. Studies have suggested that timed sequential salvage combination cytotoxic chemotherapy may be particularly useful for that indication. We report here a series of ten such adult patients treated sequentially at a single center with EMA (cytarabine 500 mg/m 2 /day as continuous infusion on days 1-3 and days 8-10, mitoxantrone 12 mg/m 2 /day on days 1-3, and etoposide 200 mg/m 2 /day as continuous infusion on days 8-10). The overall complete remission rate was 40% (including 3 of 4 of those with relapsed disease), but use of this regimen was associated with prolonged cytopenia and a high rate of infectious adverse events. Even with the availability of modern infectious prophylaxis and therapies, the EMA regimen is likely best reserved for those with relapsed disease treated with curative intent prior to an allogeneic hematopoietic cell transplant.

Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

“…As stated above, because of the poor prognosis associated with FLT3-ITD mutated AML, allo-SCT was most frequently performed in patients in CR1 [66][67][68][69][70][71][72][73][74]102 including fit patients ≥60 years of age. 103 In most studies, the LFS rate at 2 years ranges between 50 to 60% in that setting, 66,92,97,104 although a wide variation from 20% 70,105 to 70% 69 has been reported.…”

B Cell Deficiency in Patients with Relapsed and Refractory Acute Myeloid Leukemia

“…Bone marrow aspirate was collected from patients with R-AML at the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) [5,6]. Adult HD were recruited for BM aspirate collection at the NIH; all subjects were screened on IRB-approved protocols and provided written informed consent.…”

Drug responsiveness of leukemic cells detected in vitro at diagnosis correlates with therapy response and survival in patients with acute myeloid leukemia

“…The common approaches to overcome drug resistance in clinical practice are the administration of cytotoxic drugs not previously used by the particular patient 33 ; a shift to high doses of previously used cytotoxic drugs 34 ; continuous exposure to low doses of chemotherapeutic drugs 35 ; induction of tumor cell differentiation 36 ; use of drugs based on herbal extracts and their derivatives which have a wide range of biological activities 37 , 38 and may inhibit the binding of cytostatics with P‐glycoprotein. 39 All these approaches can be used both independently and in combination with standard chemotherapy.…”