Crespo-Solís E, Rosas-López A, Vera-Zertuche M

Language: Spanish
References: 12
Page: 15-20
PDF size: 605.19 Kb.

ABSTRACT

Background: On previous reports we have informed complete remission (CR) rates in patients with acute myeloid leukemia (AML) treated with chemotherapy 7+3 similar to those reported in the literature. Although incidence of early death during post-chemotherapy bone marrow aplasia is also similar to those reported by other groups, the CR rate after only one 7+3 cycle is considered suboptimal. This could be related to weak chemotherapy regimens or to a biologically more aggressive disease in our patients. Since 2010 we implemented more aggressive chemotherapy regimens in younger patients with AML (≤ 55 years) in order to improve the CR rate.
Methods: In this retrospective study we evaluated a series of adult patients with AML treated at our center between November 2010 and June 2012. The induction regimens used were 7+3+7E which consists of cytarabine given at 100 mg/m2/day, on days 1-7 and daunorubicin given at 45 mg/m2 on days 1-2, plus etoposide 75 mg/m2/day, on days 1-7 of cycle 1; or intermediate-dose cytarabine which consists of cytarabine given at 3 gr/m2/day, on days 1-3 plus daunorubicin given at 45 mg/m2/day, on days 2 and 3 of cycle 1. The goal of this preliminary report was to describe the CR rate and toxicity of the 7+3+7E and intermediate dose cytarabine during induction.
Results: We reported a total of 15 patients, median age of 40 years (range, 19 to 55 years). Analyzable metaphases were obtained in 73.3% (11/15) of the cases, 27.2% (3/11) were classified as having unfavorable cytogenetis, 54.5% (6/11) intermediate and 18.1% (2/11) favorable. Performance status was assessed by the ECOG scoring system, 80% of the patients were classified as ECOG 0-2 and the remaining 20% as ECOG 3-4. Comorbidities were detected in 40% of patients. Primary resistance was found in 6.6% of the patient population. The complete remission rate after the cycle 1 was 66.7%, with an early mortality rate of 13.3%, severe febrile neutropenia was observed in 100% of the patients and septic shock during induction in 6.7%. These results suggest that the use of more intensive induction regimens in younger patients with AML offers higher CR rates compared to our historical cohort of AML patients receiving 7+3 chemotherapy; with acceptable rates of septic shock and early mortality.

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