title: Gemtuzumab ozogamicin: first clinical experiences in children with relapsed/refractory acute myeloid leukemia treated on compassionate-use basis.
abstract: Gemtuzumab ozogamicin (GO; Mylotarg) was developed to treat CD33(+) acute myeloid leukemia (AML). To date, only studies in adults and preliminary data from a phase 1 study in children have been reported. We report data on 15 children with relapsed/refractory CD33(+) AML who were treated with GO monotherapy on compassionate use basis (4-9 mg/m(2) up to 3 courses). Eight children showed a reduction in bone marrow blasts to 5% or less, including 5 in complete remission without full platelet recovery (CRp). Three of the 5 children with CRp received transplants almost directly following the last GO course, without awaiting further platelet regeneration. Hence in these children no clear discrimination between complete remission (CR) and CRp could be made. In 6 of 8 responding patients further treatment was given consisting of stem cell transplantation (SCT). Two patients are still alive, currently 6 and 9 months after SCT. Hematologic toxicity was difficult to assess due to subsequent SCT or leukemia. Side effects, in one patient each included veno-occlusive disease, transient grade 3 hyperbilirubinemia, transient grade 3 transaminase elevation, and grade 3 hypotension during GO administration. No infections or mucositis occurred. This report demonstrates clinical efficacy of GO in a subset of relapsed/refractory pediatric CD33(+) AML patients and suggests that intensive postremission therapy after remission induction by GO may result in durable responses in some patients, although follow-up is still short. Further studies are needed to determine the efficacy and safety of GO in children with AML.
authors.affiliation: Department of Pediatric Hematology/Oncology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands. cm.zwaan@vumc.nl
authors.forename: Christian M
authors.initials: CM
authors.lastname: Zwaan
authors.forename: Dirk
authors.initials: D
authors.lastname: Reinhardt
authors.forename: Selim
authors.initials: S
authors.lastname: Corbacioglu
authors.forename: Elisabeth R
authors.initials: ER
authors.lastname: van Wering
authors.forename: Jos P M
authors.initials: JP
authors.lastname: Bökkerink
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.forename: Ulf
authors.initials: U
authors.lastname: Samuelsson
authors.forename: Jay
authors.initials: J
authors.lastname: Feingold
authors.forename: Ursula
authors.initials: U
authors.lastname: Creutzig
authors.forename: Gertjan J L
authors.initials: GJ
authors.lastname: Kaspers
mesh_terms: D000293:Adolescent; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D001854:Bone Marrow Cells / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D000079982:Gemtuzumab; D006801:Humans; D000922:Immunotoxins / Q000627:therapeutic use; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000922:Immunotoxins; D000079982:Gemtuzumab