title: Mitoxantrone and etoposide: an effective regimen for refractory or relapsed acute myelogenous leukemia.
abstract: 23 adult patients with refractory or relapsed acute myelogenous leukemia (AML) received salvage chemotherapy with mitoxantrone and etoposide. The regimen consisted of mitoxantrone, 10 mg/m2/d by 30-min infusion, and etoposide 100 mg/m2/d by 30-min infusion, given 12 h apart for 5 consecutive d. Of 23 patients treated, 13 met the criteria for highly refractory disease (6 primary resistant; 4 with early relapse during maintenance; 3 relapsed and refractory to reinduction). 10 patients had relapsed off-therapy more than 6 months after achieving first CR. Overall, 14 patients (61%) achieved a complete remission (CR): 6/13 (46%) with refractory AML, and 8/10 (80%) with relapsed AML. 2 patients had a partial remission, 2 died in aplasia, and 5 were nonresponders. In responding patients, the median time for recovery of granulocyte count was 27 d. The most important nonhematologic side effect was oral mucositis, which was severe in 35% of cases. No signs of cardiac toxicity were observed. The median CR duration was 5 months (range, 2 to 12+ months). The combination of mitoxantrone and etoposide appears a highly effective and relatively well tolerated salvage regimen for refractory and relapsed AML. Its incorporation into first-line induction and consolidation programs for newly diagnosed AML patients should be considered.
authors.affiliation: Division of Hematology, Istituto Scientifico Policlinico S. Matteo, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lazzarino
authors.forename: E
authors.initials: E
authors.lastname: Morra
authors.forename: E P
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: E
authors.initials: E
authors.lastname: Orlandi
authors.forename: G
authors.initials: G
authors.lastname: Pagnucco
authors.forename: S
authors.initials: S
authors.lastname: Merante
authors.forename: P
authors.initials: P
authors.lastname: Bernasconi
authors.forename: D
authors.initials: D
authors.lastname: Inverardi
authors.forename: M
authors.initials: M
authors.lastname: Bonfichi
authors.forename: C
authors.initials: C
authors.lastname: Bernasconi
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001769:Blood / Q000187:drug effects; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D008942:Mitoxantrone / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors
chemical_list: D005047:Etoposide; D008942:Mitoxantrone