title: Fludarabine and cytarabine in patients with acute myeloid leukemia refractory to two different courses of front-line chemotherapy.
abstract: The most effective regimen for acute myeloid leukemia (AML) patients who do not achieve complete remission (CR) after two different courses of front-line chemotherapy has not been established. We therefore evaluated the efficacy, toxicity, and prognostic factors for achieving CR following treatment with fludarabine and cytarabine in 25 newly diagnosed AML patients who did not respond to initial therapy with idarubicin and cytarabine followed by mitoxantrone and etoposide. CR was achieved in 32% of patients; in 55% of patients with intermediate-risk karyotype and in 14% with unfavorable-risk. Eight percent died of infectious complications. Median duration of overall survival was 6.6 months (95% CI 3.4 months to ∞); 3.4 months (95% CI 0.8-8.6 months) for patients with an unfavorable-risk karyotype and 18.1 months (95% CI 5.0 months to ∞) with an intermediate-risk karyotype (p=0.02). Our data suggest that poor-risk karyotype patients are unlikely to benefit from third course treatment with fludarabine-cytarabine, and that this regimen merits further investigation in AML patients with good or intermediate-risk karyotype that have persistent leukemia after two courses of front-line chemotherapy.
authors.affiliation: Division of Hematology and Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
authors.forename: Dhaval R
authors.initials: DR
authors.lastname: Mehta
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Foon
authors.forename: Robert L
authors.initials: RL
authors.lastname: Redner
authors.forename: Anastasios
authors.initials: A
authors.lastname: Raptis
authors.forename: Mounzer
authors.initials: M
authors.lastname: Agha
authors.forename: Jing-Zhou
authors.initials: JZ
authors.lastname: Hou
authors.forename: Shrina
authors.initials: S
authors.lastname: Duggal
authors.forename: The Minh
authors.initials: TM
authors.lastname: Luong
authors.forename: James J
authors.initials: JJ
authors.lastname: Schlesselman
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003561:Cytarabine / Q000008:administration & dosage; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine; D015255:Idarubicin