title: Mitoxantrone and cytosine arabinoside as treatment for acute myeloblastic leukemia in older patients.
abstract: The majority of patients with acute myeloid leukemia (AML) are elderly, and their response to chemotherapy is poorer than that of younger patients. The combination of mitoxantrone (MTN) and cytosine arabinoside (Ara-C) is a possible alternative to an anthracycline/Ara-C combination for the treatment of AML in these patients. Of 52 older patients (> 59 years) referred over a 3.5-year period, 33 patients (age range 60-78 years, median 67 years) received MTN and Ara-C as therapy for newly diagnosed AML. MTN was administered at a dose of 12 mg/m2/day, intravenously, for 3 days (23 patients), or 10 mg/m2/day for 5 days (10 patients), and Ara-C at a dose of 100 mg/m2 twice daily, intravenously, for 7 days. Complete remission (CR) was achieved in 16/33 patients (48%). The median remission duration was 6 months (range 1-37 months). The median survival was 14 months for those who achieved CR compared with 9 months for those with resistant disease. Two patients remain in first CR after 13 and 37 months, but three patients died whilst receiving consolidation therapy. In selected elderly patients with AML, the combination of MTN and Ara-C provides an acceptable alternative to an anthracycline/Ara-C regimen, with a higher CR rate than historical controls. However, the CR rate and remission duration remain low compared with those of younger patients, supporting the need to investigate new approaches to treatment in this population.
authors.affiliation: Department of Hematology, St. Bartholomew's Hospital, West Smithfield, London, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: MacCallum
authors.forename: A Z
authors.initials: AZ
authors.lastname: Rohatiner
authors.forename: C L
authors.initials: CL
authors.lastname: Davis
authors.forename: J S
authors.initials: JS
authors.lastname: Whelan
authors.forename: A M
authors.initials: AM
authors.lastname: Oza
authors.forename: J
authors.initials: J
authors.lastname: Lim
authors.forename: S
authors.initials: S
authors.lastname: Love
authors.forename: J A
authors.initials: JA
authors.lastname: Amess
authors.forename: M
authors.initials: M
authors.lastname: Leahy
authors.forename: R K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D009504:Neutrophils / Q000187:drug effects; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D008942:Mitoxantrone