Mitoxantrone, Etoposide, Carboplatinum and Ara-C Combination Therapy (Meca) in Refractory and Relapsed Acute Leukemia

Abstract

The present study was undertaken to assess the feasibility, toxicity and antileukemic activity of sequential chemotherapy including mitoxantrone, etoposide, carboplatin and intermediate-dose cytarabine in adult patients with refractory and relapsed acute myelogenous (AML) or lymphoid (ALL) leukemia. Fifty-one patients with poor-risk AML and ALL received 64 courses of MECA therapy. The overall response in the entire group was 51% (43% complete remission). The stage of the disease (relapsed or primarily refractory) and the age of the patients did not strongly affect the response rate. MECA therapy was more effective in ALL than in AML, and in those patients who presented at salvage treatment with a bone marrow infiltration lower than 25% blasts. Hematological and extra-hematological toxicities were tolerable and there were 6 deaths related to the treatment (11%). The incidence of documented infectious episodes was 71%. MECA therapy is a safe treatment and has a high antileukemic activity in relapsed and primarily refractory AML or ALL.

A multicenter, open, non‐comparative, phase II study of the combination of cladribine (2‐chlorodeoxyadenosine), cytarabine, and G‐CSF as induction therapy in refractory acute myeloid leukemia – a report of the Polish Adult Leukemia Group (PALG)

“…DFS and OS probability of 1 yr in this study group of patients in CR was 29% and 65%, respectively, which is, at least, similar to the results obtained with other salvage regimens (3–9).…”

“…There is no consensus as to how to manage this poor‐risk refractory AML. Most salvage therapies are based on the combination regimens, using various doses of Ara‐C, the most active drug in AML, with a variety of other agents (3–9).…”

“…Most salvage therapies which have been studied in patients with refractory or relapsed AML are combination regimens, using various doses of arabinoside cytosine (Ara‐C) with a variety of other agents. The number of patients achieving CR with these regimens is low (16–44%) with usually short disease‐free (DFS) and overall survival (OS) (3–12). The assessment of treatment results from refractory AML patients diagnosed with this poor prognosis is usually hindered by the small number of subjects within the analyzed groups, the small number of multicenter prospective trials, and often the inclusion of the analysis of patients with CR1 of a longer duration.…”

Cladribine combined with high doses of arabinoside cytosine, mitoxantrone, and G‐CSF (CLAG‐M) is a highly effective salvage regimen in patients with refractory and relapsed acute myeloid leukemia of the poor risk: a final report of the Polish Adult Leukemia Group

“…In this setting, the formal comparison of our results to other salvage regimens of similar intensity is difficult because of the heterogeneity of included patients, which significantly influences the outcome. In most of the studies, patients with poor risk de novo AML, refractory AML and patients with early and late relapse were enrolled (6, 7, 9, 15, 21, 22, 41–43). Moreover, in contrast to our report, many other studies have only included small numbers of patients, which makes it difficult to identify and confirm the best treatment option in this poor risk group.…”

FLANG salvage chemotherapy is an effective regimen that offers a safe bridge to transplantation for patients with relapsed or refractory acute myeloid leukemia

“…High-or intermediate-dose Ara-C has been reported to be an effective salvage treatment in AML [5][6][7][8][9]. Cumulative knowledge of the pharmacology of Ara-C-the single most effective agent and the basis for the vast majority of combination regimens in AML-has provided the basis for the modification of AML treatment regimens.…”