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High-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor remission induction therapy for previously untreated de novo and secondary adult acute myeloid leukemia.
Semin Oncol. 1993 Dec; 20(6 Suppl 8):6-12.SO

Abstract

This report describes the preliminary results of the remission induction phase of a protocol for previously untreated de novo and secondary acute myeloid leukemia (AML) designed to deliver very intensive therapy over a brief period of time using hematopoietic growth factor support. Remission induction therapy consisted of cytarabine 3 g/m2 (1.5 g/m2 for age > 50 years) intravenously over 1 hour every 12 hours for 12 doses and idarubicin 12 mg/m2 over 30 minutes on days 2, 3, and 4 of cytarabine, followed by 10 micrograms/kg granulocyte colony-stimulating factor subcutaneously daily until the absolute neutrophil count increased to > or = 5.0 x 10(9)/L on 2 consecutive days. Twenty-seven patients received all the planned doses of chemotherapy. The complete remission (CR) rate to a single course of therapy was 65% in 20 patients with de novo AML (median age, 60.5 years; age range, 26 to 78 years); for those aged less than 60 and > or = 60 years, the CR rates were 90% and 40%, respectively. In contrast, only two of 10 patients with secondary AML (median age, 68 years; age range, 35 to 77 years) achieved a CR. The median time from initiation of chemotherapy to recovery of 0.5 x 10(9)/L neutrophils in de novo AML patients achieving CR was 20 days (range, 18 to 23 days). Median times to last platelet transfusion and to 100 x 10(9)/L platelet count were 23 days (range, 18 to 41 days) and 28 days (range, 24 to 97 days), respectively. The major nonhematologic toxicity was transient hyperbilirubinemia, which was observed in 64% of patients. Reversible cerebellar toxicity was seen in three patients. Thus, idarubicin at full dose (12 mg/m2 x 3 days) may be safely administered with high-dose cytarabine, even in elderly patients. The use of granulocyte colony-stimulating factor is associated with rapid neutrophil recovery without obvious toxicity. The CR rate for de novo AML patients treated with a single course of high-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor is at least comparable to CR rates achieved with standard-dose cytarabine and anthracycline regimens. The response of secondary AML patients remains inferior.

Authors+Show Affiliations

Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7507264

Citation

Baer, M R., et al. "High-dose Cytarabine, Idarubicin, and Granulocyte Colony-stimulating Factor Remission Induction Therapy for Previously Untreated De Novo and Secondary Adult Acute Myeloid Leukemia." Seminars in Oncology, vol. 20, no. 6 Suppl 8, 1993, pp. 6-12.
Baer MR, Christiansen NP, Frankel SR, et al. High-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor remission induction therapy for previously untreated de novo and secondary adult acute myeloid leukemia. Semin Oncol. 1993;20(6 Suppl 8):6-12.
Baer, M. R., Christiansen, N. P., Frankel, S. R., Brunetto, V. L., Mrózek, K., Bloomfield, C. D., & Herzig, G. P. (1993). High-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor remission induction therapy for previously untreated de novo and secondary adult acute myeloid leukemia. Seminars in Oncology, 20(6 Suppl 8), 6-12.
Baer MR, et al. High-dose Cytarabine, Idarubicin, and Granulocyte Colony-stimulating Factor Remission Induction Therapy for Previously Untreated De Novo and Secondary Adult Acute Myeloid Leukemia. Semin Oncol. 1993;20(6 Suppl 8):6-12. PubMed PMID: 7507264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor remission induction therapy for previously untreated de novo and secondary adult acute myeloid leukemia. AU - Baer,M R, AU - Christiansen,N P, AU - Frankel,S R, AU - Brunetto,V L, AU - Mrózek,K, AU - Bloomfield,C D, AU - Herzig,G P, PY - 1993/12/1/pubmed PY - 1993/12/1/medline PY - 1993/12/1/entrez SP - 6 EP - 12 JF - Seminars in oncology JO - Semin Oncol VL - 20 IS - 6 Suppl 8 N2 - This report describes the preliminary results of the remission induction phase of a protocol for previously untreated de novo and secondary acute myeloid leukemia (AML) designed to deliver very intensive therapy over a brief period of time using hematopoietic growth factor support. Remission induction therapy consisted of cytarabine 3 g/m2 (1.5 g/m2 for age > 50 years) intravenously over 1 hour every 12 hours for 12 doses and idarubicin 12 mg/m2 over 30 minutes on days 2, 3, and 4 of cytarabine, followed by 10 micrograms/kg granulocyte colony-stimulating factor subcutaneously daily until the absolute neutrophil count increased to > or = 5.0 x 10(9)/L on 2 consecutive days. Twenty-seven patients received all the planned doses of chemotherapy. The complete remission (CR) rate to a single course of therapy was 65% in 20 patients with de novo AML (median age, 60.5 years; age range, 26 to 78 years); for those aged less than 60 and > or = 60 years, the CR rates were 90% and 40%, respectively. In contrast, only two of 10 patients with secondary AML (median age, 68 years; age range, 35 to 77 years) achieved a CR. The median time from initiation of chemotherapy to recovery of 0.5 x 10(9)/L neutrophils in de novo AML patients achieving CR was 20 days (range, 18 to 23 days). Median times to last platelet transfusion and to 100 x 10(9)/L platelet count were 23 days (range, 18 to 41 days) and 28 days (range, 24 to 97 days), respectively. The major nonhematologic toxicity was transient hyperbilirubinemia, which was observed in 64% of patients. Reversible cerebellar toxicity was seen in three patients. Thus, idarubicin at full dose (12 mg/m2 x 3 days) may be safely administered with high-dose cytarabine, even in elderly patients. The use of granulocyte colony-stimulating factor is associated with rapid neutrophil recovery without obvious toxicity. The CR rate for de novo AML patients treated with a single course of high-dose cytarabine, idarubicin, and granulocyte colony-stimulating factor is at least comparable to CR rates achieved with standard-dose cytarabine and anthracycline regimens. The response of secondary AML patients remains inferior. SN - 0093-7754 UR - https://www.unboundmedicine.com/medline/citation/7507264/High_dose_cytarabine_idarubicin_and_granulocyte_colony_stimulating_factor_remission_induction_therapy_for_previously_untreated_de_novo_and_secondary_adult_acute_myeloid_leukemia_ L2 - http://www.diseaseinfosearch.org/result/4195 DB - PRIME DP - Unbound Medicine ER -