Effective salvage therapy for high-risk relapsed or refractory acute myeloid leukaemia with cisplatin in combination with high-dose cytarabine and etoposide.
OBJECTIVE
This study aimed at evaluating the efficacy and toxicity of the combination regimen of high-dose cytarabine, etoposide and cisplatin (HAEP) in adult patients with high-risk relapsed or refractory acute myeloid leukaemia (AML).


METHODS
From January 2001 to December 2012, 49 relapsed or refractory AML patients [36 men; 13 women; median age, 42 (range, 18-71) yr; patients aged >60 yr, 8] were treated with HAEP [high-dose cytarabine (2 g/m(2) ), etoposide (100 mg/m(2) ) and cisplatin (20 mg/m(2) ) for five alternative days] as salvage therapy. Patients who had the first relapse at <6 months after an initial complete remission (CR), had a second or subsequent relapse, were primary refractory to ≥2 courses of front-line conventional induction chemotherapy or were refractory to re-induction chemotherapy after any relapse was eligible for HAEP treatments.


RESULTS
The overall CR + CR without platelet recovery (CRp) rates among 49 evaluable patients were 31% [95% confidence interval (CI), 17-44%]. Of the eight patients aged ≥60 yr, none showed any response to HAEP treatment. The CR + CRp rate was 54% in patients with second or greater relapse and 25% in patients refractory to re-induction therapy after relapse. In multivariate analysis, younger age, favourable cytogenetics and no prior salvage chemotherapy were independent predictors for better responses.


CONCLUSIONS
Our findings suggest that HAEP is an effective salvage chemotherapy for patients aged <60 yr with high-risk relapsed or refractory AML.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Yun-Gyoo
YG
Lee
Ji-hyun
JH
Kwon
Inho
I
Kim
Sung Soo
SS
Yoon
Jong-Seok
JS
Lee
Seongyang
S
Park
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin
acute myeloid leukaemia; cisplatin; cytarabine; etoposide; salvage