title: Fludarabine and cytarabine in patients with relapsed acute myeloid leukemia refractory to initial salvage therapy.
abstract: The most effective regimen for relapsed acute myeloid leukemia (AML) patients who do not achieve complete remission (CR) after a course of salvage therapy has not been established. We evaluated the efficacy and toxicity of fludarabine and cytarabine in patients with AML in first relapse who did not respond to a course of salvage chemotherapy with mitoxantrone and etoposide. CR was achieved in 39 % of treated patients, and in 47 % of patients with a favorable/intermediate-risk karyotype. The median overall survival was 4.75 months. The median survival for patients achieving CR with fludarabine-cytarabine was significantly higher than for those who did not respond to therapy (9.6 vs. 4.5 months, P = 0.04). Our data suggest that the fludarabine-cytarabine regimen merits further investigation in relapsed AML patients with favorable or intermediate-risk karyotype with persistent leukemia after a course of salvage therapy.
authors.affiliation: Division of Hematology and Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15232, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: McLaughlin
authors.forename: Annie
authors.initials: A
authors.lastname: Im
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: Robert
authors.initials: R
authors.lastname: Redner
authors.forename: Shrina
authors.initials: S
authors.lastname: Duggal
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Clay
authors.initials: C
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D059785:Karyotype; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000235:genetics; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine