Cyclophosphamide combined with mitoxantrone and cytarabine is an effective salvage regimen for patients with acute myeloid leukemia who experienced primary induction failure or relapse

Abstract

Abstract. Salvage regimens containing mitoxantrone have been successfully used for the treatment of primary induction failure or relapsed acute myeloid leukemia. However, the combination of cyclophosphamide with mitoxantrone and cytarabine (MAC) has never been assessed in these patients. A total of 91 patients, including patients with primary induction failure (n=44) and relapsed (n=47), were treated with a salvage MAC regimen, which consisted of mitoxantrone, cytarabine and cyclophosphamide. The overall complete remission rate was 74.7 (68/91) and 72.7% (32/44) for primary induction failure, and 76.6% (36/47) for relapsed patients. The overall survival rate and disease-free survival rate were 72.1 and 59.7% at 1 year, 42.9 and 47.1% at 3 years, and 36.7 and 43.0% at 5 years, respectively. Only one patient succumbed to mortality during induction therapy. The toxicity level was acceptable. Therefore, the present study demonstrated that MAC is a highly effective and well-tolerated regimen for salvage in patients experiencing primary induction failure or relapse. This treatment significantly improved the prognosis.

Combination of cyclophosphamide and cytarabine as induction regimen for newly diagnosed adult acute myeloid leukemia

“…The overall response rate (ORR) of adult refractory/relapsed AML is up to 56.7% using medium‐/high‐dose Ara‐C combined with CTX [ 17 ]. A salvage MAC protocol (mitoxantrone + Ara‐C + CTX) also achieved ORR of 70% in AML patients with primary induction failure or relapse [ 18 ]. However, the efficacy of CTX in the first‐line treatment of AML has not been reported.…”