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Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia.
Ann Hematol. 2004 Aug; 83(8):498-503.AH

Abstract

In an attempt to improve the complete remission (CR) rates and to prolong the remission duration especially in elderly patients > 50 years of age, we have used a combination chemotherapy of idarubicin (10 mg/m2 IV x 3 days), cytarabine (AraC, 100 mg/m2 CIVI x 7d), and etoposide (100 mg/m2 x 5 days) in combination with granulocyte colony-stimulating factor (G-CSF) priming [5 mg/kg SQ day 1 until absolute neutrophil count (ANC) recovery] for remission induction. Responding patients received two consolidation courses of idarubicin, AraC, and etoposide, followed by a late consolidation course of intermediate-dose AraC (600 mg/m2 IV every 12 h x 5 days) and amsacrine (60 mg/m2 IV x 5 days). A total of 112 patients (57 male/55 female) with a median age of 58 years (range: 22-75) have been entered and are evaluable for response: 19 refractory anemia with excess of blast cells in transformation (RAEB-T), 84 acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS), and 9 secondary AML after chemotherapy/radiotherapy. The overall CR rate was 62%, partial remission (PR) rate 10%, treatment failure 16%, and early death rate 12%. The CR rate was higher in patients < or = 60 years (68 vs 55%), mainly due to a lower early death rate (5 vs 21%, p<0.001). After a median follow-up of 58 months, the median overall survival is 14.5% and median duration of relapse-free survival 8 months. After 60 months, the probability of CR patients to still be in CR and alive is 16% (20% in patients < or = 60 years and 13% in patients >60 years), while the probability of overall survival is 12% (15% in patients < or = 60 years and 9% in patients > 60 years). Compared to our previous trial (AML-MDS Study 01-92) which was done with identical chemotherapy but no G-CSF priming in 110 patients with RAEB-T, AML after MDS, or secondary AML (identical median age, age range, and distribution of subtypes), the CR rate in all patients, as well as CR rate, overall survival, and relapse-free survival in patients > 60 years have significantly been improved. Thus, intensive chemotherapy with G-CSF priming is both well tolerated and highly effective for remission induction in these high-risk patients.

Authors+Show Affiliations

Department of Hematology/Oncology, Johann Wolfgang Goethe University Hospital, University of Frankfurt/Main, Theodor-Stern-Kai 7, Frankfurt/Main, Germany. w.k.hofmann@em.uni-frankfurt.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15156346

Citation

Hofmann, W K., et al. "Intensive Chemotherapy With Idarubicin, Cytarabine, Etoposide, and G-CSF Priming in Patients With Advanced Myelodysplastic Syndrome and High-risk Acute Myeloid Leukemia." Annals of Hematology, vol. 83, no. 8, 2004, pp. 498-503.
Hofmann WK, Heil G, Zander C, et al. Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia. Ann Hematol. 2004;83(8):498-503.
Hofmann, W. K., Heil, G., Zander, C., Wiebe, S., Ottmann, O. G., Bergmann, L., Hoeffken, K., Fischer, J. T., Knuth, A., Kolbe, K., Schmoll, H. J., Langer, W., Westerhausen, M., Koelbel, C. B., Hoelzer, D., & Ganser, A. (2004). Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia. Annals of Hematology, 83(8), 498-503.
Hofmann WK, et al. Intensive Chemotherapy With Idarubicin, Cytarabine, Etoposide, and G-CSF Priming in Patients With Advanced Myelodysplastic Syndrome and High-risk Acute Myeloid Leukemia. Ann Hematol. 2004;83(8):498-503. PubMed PMID: 15156346.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive chemotherapy with idarubicin, cytarabine, etoposide, and G-CSF priming in patients with advanced myelodysplastic syndrome and high-risk acute myeloid leukemia. AU - Hofmann,W K, AU - Heil,G, AU - Zander,C, AU - Wiebe,S, AU - Ottmann,O G, AU - Bergmann,L, AU - Hoeffken,K, AU - Fischer,J T, AU - Knuth,A, AU - Kolbe,K, AU - Schmoll,H J, AU - Langer,W, AU - Westerhausen,M, AU - Koelbel,C B, AU - Hoelzer,D, AU - Ganser,A, Y1 - 2004/05/20/ PY - 2003/11/15/received PY - 2003/11/23/accepted PY - 2004/5/25/pubmed PY - 2004/9/15/medline PY - 2004/5/25/entrez SP - 498 EP - 503 JF - Annals of hematology JO - Ann Hematol VL - 83 IS - 8 N2 - In an attempt to improve the complete remission (CR) rates and to prolong the remission duration especially in elderly patients > 50 years of age, we have used a combination chemotherapy of idarubicin (10 mg/m2 IV x 3 days), cytarabine (AraC, 100 mg/m2 CIVI x 7d), and etoposide (100 mg/m2 x 5 days) in combination with granulocyte colony-stimulating factor (G-CSF) priming [5 mg/kg SQ day 1 until absolute neutrophil count (ANC) recovery] for remission induction. Responding patients received two consolidation courses of idarubicin, AraC, and etoposide, followed by a late consolidation course of intermediate-dose AraC (600 mg/m2 IV every 12 h x 5 days) and amsacrine (60 mg/m2 IV x 5 days). A total of 112 patients (57 male/55 female) with a median age of 58 years (range: 22-75) have been entered and are evaluable for response: 19 refractory anemia with excess of blast cells in transformation (RAEB-T), 84 acute myeloid leukemia (AML) evolving from myelodysplastic syndrome (MDS), and 9 secondary AML after chemotherapy/radiotherapy. The overall CR rate was 62%, partial remission (PR) rate 10%, treatment failure 16%, and early death rate 12%. The CR rate was higher in patients < or = 60 years (68 vs 55%), mainly due to a lower early death rate (5 vs 21%, p<0.001). After a median follow-up of 58 months, the median overall survival is 14.5% and median duration of relapse-free survival 8 months. After 60 months, the probability of CR patients to still be in CR and alive is 16% (20% in patients < or = 60 years and 13% in patients >60 years), while the probability of overall survival is 12% (15% in patients < or = 60 years and 9% in patients > 60 years). Compared to our previous trial (AML-MDS Study 01-92) which was done with identical chemotherapy but no G-CSF priming in 110 patients with RAEB-T, AML after MDS, or secondary AML (identical median age, age range, and distribution of subtypes), the CR rate in all patients, as well as CR rate, overall survival, and relapse-free survival in patients > 60 years have significantly been improved. Thus, intensive chemotherapy with G-CSF priming is both well tolerated and highly effective for remission induction in these high-risk patients. SN - 0939-5555 UR - https://www.unboundmedicine.com/medline/citation/15156346/Intensive_chemotherapy_with_idarubicin_cytarabine_etoposide_and_G_CSF_priming_in_patients_with_advanced_myelodysplastic_syndrome_and_high_risk_acute_myeloid_leukemia_ L2 - https://dx.doi.org/10.1007/s00277-004-0889-0 DB - PRIME DP - Unbound Medicine ER -