title: A phase II study of timed sequential therapy of acute myelogenous leukemia (AML) for patients over the age of 60: two cycle timed sequential therapy with topotecan, ara-C and mitoxantrone in adults with poor-risk AML.
abstract: Acute myeloid leukemia (AML) in the elderly is a serious problem characterized by poor response to therapy and short survival. To improve response to therapy, a timed sequential therapy (TST) approach was designed utilizing topotecan, cytosine arabinoside (ara-C) and mitoxantrone based on multiple studies suggesting that topotecan and mitoxantrone are effective in older patients. Thirty-two adults, >or=60-year-old (median age 69) were included. None had favorable cytogenetics and 44% had and antecedent myelodysplastic syndrome (MDS) or 2 degrees AML. Fifty-nine percent achieved a complete response (CR). Median overall survival (OS) was 6.5 months (95% confidence interval (CI): 3.1-12.0 months; range, 15 days to 25.3 months). Disease-free survival (DFS) for the 19 patients achieving a CR was 7.7 months (95% CI: 6.1-13.7 months; range, 2.9-25.3 months). There were no differences in OS or DFS between cytogenetic or disease etiology groups. Although TST was well tolerated, long-term results in this group of patients are not satisfactory and new approaches are needed.
authors.affiliation: University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: Chuanfa
authors.initials: C
authors.lastname: Guo
authors.forename: Ivana
authors.initials: I
authors.lastname: Gojo
authors.forename: Judith E
authors.initials: JE
authors.lastname: Karp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D009190:Myelodysplastic Syndromes / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D019772:Topotecan / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D019772:Topotecan; D008942:Mitoxantrone