Skip to main content
Log in

Comparison of Mitoxantrone in Combination with Intermediate-dose Cytarabine versus High-dose Cytarabine as Consolidation Therapies for Young Non-APL Acute Myeloid Leukemia Patients with Favorable and Intermediate Cytogenetics

  • Published:
Current Medical Science Aims and scope Submit manuscript

Abstract

In this study, we compared the efficacy of mitoxantrone in combination with intermediate-dose cytarabine (HAM) with that of high-dose cytarabine alone (HiDAC) as consolidation regimens in non-acute promyelocytic leukemia (APL) acute myeloid leukemia patients with favorable and intermediate cytogenetics. A total of 62 patients from Shenzhen People's Hospital were enrolled in this study. All patients enrolled received standard induction chemotherapy and achieved the first complete remission (CR1). In these patients, 24 received HiDAC and 38 received HAM as consolidation. The median relapse free survival (RFS) and overall survival (OS) were similar between these two consolidation regimens. Even in subgroup analysis according to risk stratification, the combination regimen conferred no benefit in longterm outcome in patients with favorable or intermediate cytogenetics. However, in patients receiving HAM regimen, the lowest neutrophil count was lower, neutropenic period longer, neutropenic fever rate higher, and more platelet transfusion support was required. HAM group also tended to have higher rate of sepsis than HiDAC group. According to our results, we suggest that combination treatment with mitoxantrone and intermediate-dose cytarabine has limited value as compared to HiDAC, even in young non-APL AML patients with favorable and intermediate cytogenetics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dombret H, Gardin C. An update of current treatments for adult acute myeloid leukemia. Blood, 2016, 127(1): 53–61

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Mayer RJ, Davis RB, Schiffer CA, etal. Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. N Engl J Med, 1994, 331(14): 896–903

    Article  PubMed  CAS  Google Scholar 

  3. Bloomfield CD, Lawrence D, Byrd JC, etal. Frequency of prolonged remission duration after highdose cytarabine intensification in acute myeloid leukemia varies by cytogenetic subtype. Cancer Res, 1998, 58(18): 4173–4179

    PubMed  CAS  Google Scholar 

  4. De Kouchkovsky I, Abdul-Hay M. Acute myeloid leukemia: a comprehensive review and 2016 update. Blood Cancer J, 2016,6(7): e441

    Google Scholar 

  5. Lowenberg B. Sense and nonsense of high-dose cytarabine for acute myeloid leukemia. Blood, 2013,121(1): 26–28

    Article  PubMed  Google Scholar 

  6. Schaich M, Rollig C. Soucek S, etal. Cytarabine dose of 36 g/m2 compared with 12 g/m2 within first consolidation in acute myeloid leukemia: results of patients enrolled onto the prospective randomized AML96 study. J Clin Oncol, 2011, 29(19): 2696–2702

    Article  PubMed  CAS  Google Scholar 

  7. Lowenberg B, Pabst T, vellenga E, etal. Cytarabine dose for acute myeloid leukemia. N Engl J Med, 2011, 364(11): 1027–1036

    Article  PubMed  Google Scholar 

  8. Mandelli F, Vignetti M, Suciu S, etal. Daunorubicin versus mitoxantrone versus idarubicin as induction and consolidation chemotherapy for adults with acute myeloid leukemia: the EORTC and GIMEMA Groups Study AML-10. J Clin Oncol, 2009, 27(32): 5397–5403

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Larson SM, Campbell NP, Huo D, etal. High dose cytarabine and mitoxantrone: an effective induction regimen for high-risk acute myeloid leukemia (AML). Leuk Lymphoma, 2012, 53(3): 445–450

    Article  PubMed  CAS  Google Scholar 

  10. Schlenk RF, Germing U, Hartmann F, etal. Highdose cytarabine and mitoxantrone in consolidation therapy for acute promyelocytic leukemia. Leukemia, 2005, 19(6): 978–983

    Article  PubMed  CAS  Google Scholar 

  11. Trifilio SM, Rademaker AW, Newman D, etal. Mitoxantrone and etoposide with or without intermediate dose cytarabine for the treatment of primary induction failure or relapsed acute myeloid leukemia. Leuk Res, 2012, 36(4): 394–396

    Article  PubMed  CAS  Google Scholar 

  12. O'Donnell MR, Tallman MS, Abboud CN, etal. Acute myeloid leukemia, version 2.2013. J Natl Compr Cane Netw, 2013, 11(9): 1047–1055

    Article  CAS  Google Scholar 

  13. Cheson BD, Bennett JM, Kopecky KJ, etal. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol, 2003,21 (24): 4642–4649

    Article  PubMed  Google Scholar 

  14. Miyawaki S, Ohtake S, Fujisawa S, etal. A randomized comparison of 4 courses of standard-dose multiagent chemotherapy versus 3 courses of high-dose cytarabine alone in postremission therapy for acute myeloid leukemia in adults: the JALSG AML201 Study. Blood, 2011, 117(8): 2366–2372

    Article  PubMed  CAS  Google Scholar 

  15. Thomas X, Elhamri M, Raffoux E, etal, Comparison of high-dose cytarabine and timed-sequential chemotherapy as consolidation for younger adults with AML in first remission: the ALFA-9802 study. Blood, 2011, 118(7): 1754–1762

    Article  PubMed  CAS  Google Scholar 

  16. Schaich M, Parmentier S, Kramer M, etal. High-dose cytarabine consolidation with or without additional amsacrine and mitoxantrone in acute myeloid leukemia: results of the prospective randomized AML2003 trial. J Clin Oncol, 2013, 31(17): 2094–2102

    Article  PubMed  CAS  Google Scholar 

  17. Fazlina N, Maha A, Jamal R, etal, Expression of multidrug resistance (MDR) proteins and in vitro drug resistance in acute leukemias. Hematology, 2007, 12(1): 33–37

    Article  PubMed  CAS  Google Scholar 

  18. Zhang W, Ding Y, Wu H, etal, Retrospective comparison of fludarabine in combination with intermediate-dose cytarabine versus high-dose cytarabine as consolidation therapies for acute myeloid leukemia. Medicine (Baltimore), 2014,93(27): el34

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xin-you Zhang  (张新友).

Additional information

This study was supported by grants from the Basic Research Project of Shenzhen Science and Technology Program (No. JYCJ20150403101146307, No. JCYJ20150403101028195 and No. JCYJ20160422145031770) and the National Natural Science Foundation of China (No. 81600168)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, Jh., Lin, Hq., Shen, Q. et al. Comparison of Mitoxantrone in Combination with Intermediate-dose Cytarabine versus High-dose Cytarabine as Consolidation Therapies for Young Non-APL Acute Myeloid Leukemia Patients with Favorable and Intermediate Cytogenetics. CURR MED SCI 38, 51–57 (2018). https://doi.org/10.1007/s11596-018-1845-x

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-018-1845-x

Key words

Navigation