Long‐term follow‐up of Cladribine, high‐dose Cytarabine, and Idarubicin as salvage treatment for relapsed acute myeloid leukemia and literature review

Abstract

|Eur J Haematol. 2020;104:538-545. wileyonlinelibrary.com/journal/ejh | INTRODUC TI ONRemission rates in the treatment of patients with acute myeloid leukemia (AML) have been improving over the last decades but relapse is still a matter of concern in more than 50% of all treated patients. 1 The outcome of this patient population is poor. 2 The best chance for long-term survival in relapse can be achieved with allogeneic stem cell transplantation. 3,4 Reaching again a CR before transplantation is an important step in this direction, but response rates in relapsed AML are clearly lower than in 1st-line therapy Abstract Purpose: Outcome for relapsed acute myeloid leukemia (AML) is poor. Cladribine has activity in AML, and an enhancing effect on other cytostatic drugs thus may help overcome resistance. Here, we present the final analysis of our phase II trial evaluating safety and efficacy of cladribine, cytarabine, and idarubicin (CAI) in relapsed AML. Methods: Patients with relapsed AML after at least 6 months remission received two courses of CAI. After 9 patients, prolonged neutropenia prompted protocol change (omission of idarubicin in 2nd course and dose-reduction of cytarabine). Primary endpoints were remission rate and safety. Results: Twenty patients received treatment, fourteen one, and six two courses CAI/CA. After first course, complete remission (CR/CRi) was achieved in 60%. Most frequent toxicity was infection. Median OS was 8.8 months in all patients and 21.1 months in those with CR. Nine patients (48%) proceeded to allogeneic stem cell transplantation (allo-SCT), four of those are still alive and in CR, accounting for a 5-year survival rate of 55% of transplanted patients. Conclusion: Cladribine, cytarabine, and idarubicin in relapsed AML is feasible and induces good response rates. As expected, infections are the most important complication. However, combined with allo-SCT, long-term survival can be achieved in a substantial number of patients. K E Y W O R D S allogeneic stem cell transplantation, cladribine, complete remission, infection, neutropenia, relapsed AML, treatment-related mortality

Anti-Leukemic Activity of Brassica-Derived Bioactive Compounds in HL-60 Myeloid Leukemia Cells

“…Acute myeloid leukemia (AML), like other cancers, presents a heterogeneous etiology that leads to different pathophysiology patterns, although its main features include a fast progression of the disease and a poor prognosis [ 1 ]. Currently, AML chemotherapy incorporates cytarabine, anthracycline, and cladribine individually or in combinations [ 1 , 2 ], as effective agents for cancer remission, but with numerous side effects because of their low selectivity for cancer cells [ 3 , 4 , 5 ]. Furthermore, in some cases, patients either do not respond to the used treatments or the effectiveness of these drugs is only partial and, thereby, a relapse of AML appears because of the presence of residual leukemic-resistant cells [ 6 ].…”