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Idarubicin, cytarabine, and topotecan in patients with refractory or relapsed acute myelogenous leukemia and high-risk myelodysplastic syndrome

Authors
 Seung Tae Lee  ;  Joon Ho Jang  ;  Hyung Chan Suh  ;  Jee Sook Hahn  ;  Yun Woong Ko  ;  Yoo Hong Min 
Citation
 AMERICAN JOURNAL OF HEMATOLOGY, Vol.68(4) : 237-245, 2001 
Journal Title
 AMERICAN JOURNAL OF HEMATOLOGY 
ISSN
 0361-8609 
Issue Date
2001
MeSH
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage* ; Antineoplastic Combined Chemotherapy Protocols/toxicity ; Cytarabine/administration & dosage ; Cytarabine/toxicity ; Disease-Free Survival ; Female ; Humans ; Idarubicin/administration & dosage ; Idarubicin/toxicity ; Leukemia, Myeloid, Acute/complications ; Leukemia, Myeloid, Acute/drug therapy* ; Leukemia, Myeloid, Acute/mortality ; Male ; Middle Aged ; Myelodysplastic Syndromes/complications ; Myelodysplastic Syndromes/drug therapy* ; Myelodysplastic Syndromes/mortality ; Remission Induction ; Salvage Therapy ; Survival Rate ; Topotecan/administration & dosage ; Topotecan/toxicity ; Treatment Outcome
Keywords
acute myelogenous leukemia ; myelodysplastic syndrome ; salvage chemotherapy ; topotecan ; cytarabineidarubicin
Abstract
In an effort to develop more effective therapy for patients with refractory or relapsed acute myelogenous leukemia (AML) and high-risk myelodysplastic syndrome (MDS), we investigated the efficacy of a combination chemotherapy consisting of idarubicin, cytarabine, and topotecan. Twenty-seven patients were treated: four with primary refractory AML, nine with AML in first relapse, four with AML in second relapse, and 10 with MDS-RAEB/RAEBT. Patients received as salvage therapy a single course of idarubicin 12 mg/m2 IV bolus on days 1–3, cytarabine 1 g/m2 over two hours q 12 hr on days 1–5, and topotecan 1.25 mg/m2 over 24 hr on days 1–5. Median age was 42 years (range 17–65 years). All patients were evaluable for response: 14 (51.9%) achieved complete remission, 10 with AML (59%) and four with MDS (40%), respectively. Thirteen AML patients (excluding four relapsed after autologous stem cell transplantation) were grouped into four categories to stratify the probability of achieving complete remission (CR): group 1, first CR duration > or = 2 years and receiving first salvage treatment (S1); group 2, first CR duration 1–2 years and receiving S1; group 3, first CR duration 0–1 years and receiving S1; and group 4, first CR duration 0–1 years and receiving S2, S3, or S4 after failing S1. The response rate of each group was as follows: group 1, one of two (50%); group 2, one of one (100%); group 3, four of four (100%); group 4, two of six (33.3%). The median remission duration and survival of patients with AML were six and 12 months, respectively. Median duration of survival in 10 MDS patients was 15 months, and all four MDS patients achieving a CR maintained continuous CR with a median follow-up of 11 months. Severe myelosuppression was observed in all patients, resulting in fever or documented infections in 89% of patients. Median time to recovery of neutrophils ≥0.5 × 109/l was 22 days (11–34) and for platelets > 20 × 109/l 35 days (11–58). Reversible grade 3–4 toxicities included diarrhea (two patients) and mucositis (seven patients). We conclude that combination chemotherapy with intermediate dose cytarabine, idarubicin, and topotecan has significant antileukemic activity and acceptable toxicity in salvage AML and high-risk MDS
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/ajh.1188/abstract
DOI
10.1002/ajh.1188
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/142938
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