title: Rapid induction of complete molecular remission by sequential therapy with LDAC and sorafenib in FLT3-ITD-positive patients unfit for intensive treatment: two cases and review of the literature.
abstract: Treatment of acute myeloid leukemia remains a therapeutic challenge. Even in younger patients with a low rate of co-morbidities less than 50% of patients can be cured. For older patients or patients with significant co-morbidities, the situation appears even worse. In patients not eligible for intensive treatment approaches - e.g. due to underlying medical conditions - therapeutic approaches remain almost exclusively palliative. However, even with less intense treatment approaches, temporary remission can be achieved and this contributes to prolonged survival and improved quality of life of the respective patient. Targeted therapies have been widely used as palliative treatment in- and outside clinical trials as single agents. Combination with low-dose cytarabine (LDAC) potentially improves remission rates and can be safely administered in an outpatient setting.Previous studies showed that additive hematologic toxicity of combinatory therapeutic approaches may arise from simultaneous treatment (e.g. chemotherapy plus targeted therapies). However, sequential therapies have already proven their feasibility in clinical trials. Here, we report two cases of rapid induction of complete molecular remission by sequential therapy with LDAC and sorafenib in patients unfit for intensive chemotherapy without significant long-term toxicity.
authors.affiliation: Department of Hematology and Oncology, Center of Internal Medicine, Otto-von-Guericke University Medical Center, Leipziger Str, 44, Magdeburg D-39120, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Wolleschak
authors.forename: Enrico
authors.initials: E
authors.lastname: Schalk
authors.forename: Christian
authors.initials: C
authors.lastname: Krogel
authors.forename: Tina M
authors.initials: TM
authors.lastname: Schnoeder
authors.forename: Helga
authors.initials: H
authors.lastname: Luehr
authors.forename: Kathleen
authors.initials: K
authors.lastname: Jentsch-Ullrich
authors.forename: Thomas
authors.initials: T
authors.lastname: Fischer
authors.forename: Florian H
authors.initials: FH
authors.lastname: Heidel
mesh_terms: D000368:Aged; D000918:Antibody Specificity; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008214:Lymphocytes / Q000276:immunology; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D012074:Remission Induction; D000077157:Sorafenib; D051941:fms-Like Tyrosine Kinase 3 / Q000235:genetics / Q000378:metabolism*
chemical_list: D010671:Phenylurea Compounds; D003561:Cytarabine; D009536:Niacinamide; D000077157:Sorafenib; C497970:FLT3 protein, human; D051941:fms-Like Tyrosine Kinase 3