Treatment of therapy-related myeloid neoplasms with high-dose cytarabine/mitoxantrone followed by hematopoietic stem cell transplant.
Few clinical protocols have focused on patients with therapy-related myeloid neoplasms (t-MN). Therefore, we enrolled 32 patients with previously untreated t-MN on a clinical trial testing the effectiveness of a unified induction regimen of high-dose cytarabine and mitoxantrone. The complete remission (CR) rate was 66% (95% CI 47-81%) and the partial remission (PR) rate was 16% (95% CI 5-33%), for an overall response rate of 82%. Day 30 treatment mortality was 9% (3/32), and the most serious induction toxicity was cardiac dysfunction. Among the patients with CR, 13 (62%) received consolidation therapy using an allogeneic hematopoietic cell transplant (HCT), four (21%) received an autologous HCT, and three (16%) received further chemotherapy. We observed long-term disease-free survival in patients who received all three types of consolidation therapy. The remission induction of high-dose cytarabine and mitoxantrone for t-MN is a well-tolerated efficacious combination, which allows aggressive consolidation and long-term disease-free survival.
Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA. lgodley@medicine.bsd.uchicago.edu
Lucy A
LA
Godley
Uchenna O
UO
Njiaju
Margaret
M
Green
Howard
H
Weiner
Shang
S
Lin
Olatoyosi
O
Odenike
Elizabeth S
ES
Rich
Andrew
A
Artz
Koen
K
Van Besien
Christopher K
CK
Daugherty
Yanming
Y
Zhang
Michelle M
MM
Le Beau
Wendy
W
Stock
Richard A
RA
Larson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage / Q000009:adverse effects; D022423:Myeloid Cells / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000628:therapy*; D009503:Neutropenia / Q000209:etiology; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D003561:Cytarabine; D008942:Mitoxantrone