[Clinical study on combination of homoharringtonine, Ara-C and idarubicin induction for treatment of newly diagnosed acute myeloid leukemia patients].
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The purpose of this study was to assess the efficacy and toxicity of HAI regimen [(homoharringtonine 2.5 mg/(m(2)×d), days 1 - 7; cytarabine 150 mg/(m(2)×d), days 1 - 7; idarubicin 9 mg/(m(2)×d), days 1 - 7)] for induction treatment of newly diagnosed acute myeloid leukemia (AML) (except acute promyelocytic leukemia). 31 patients with newly diagnosed AML, aged 39 (14 - 58) years, were enrolled in this clinical study. The complete remission (CR) rate, especially after one course, the overall survival (OS) rate and relapse free survival (RFS) rate were estimated. The outcomes were compared between different prognostic groups according to World Health Organization (WHO) classification, genetics and initial WBC count. Safety was evaluated using standard WHO criteria. The results showed that 26 patients (84%) achieved CR after 1 course of induction. The CR rate for the patients with favorable, intermediate and unfavorable cytogenetics was 90%, 88% and 60% respectively. All 7 patients with a high initial WBC count (≥ 100×10(9)/L) obtained CR, while 19 out of 24 without a high initial WBC count obtained CR. With a median follow-up of 15(range 2-56) months, the estimated 3-year OS rate for all patients and the patients with CR was 44% and 52% respectively. The 3-year RFS rate was 51%. The patients receiving induction chemotherapy died of the chemotherapy. Profound myelosuppression was seen in all patients after the HAI induction with the median duration of neutropenia (ANC < 0.2×10(9)/L) of 16 (6 - 24) days. As the most common toxicity, severe infections (grade III-IV) involved in all the patients and the duration of febris was 6 (1 - 36) days. The incidence of septemia and invasive fungus infection were 19.4% and 45.2% respectively. The incidence of non-infection fever, increased glutamic-pyruvic transaminase (GPT), diarrhea, increased bilirubin and oral cavity mucositis were 6.5%, 6.5%, 3.2%, 3.2%, 3.2% respectively, as the more frequent severe non-hematological toxicities. It is concluded that HAI regimen is a high efficient induction schedule for the newly diagnosed AML, and archive the higher CR rate after one course than DNR/Ara-C standard induction regimen. Side effects are acceptable, except severe infection.Keywords:
Idarubicin
Homoharringtonine
Induction chemotherapy
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Aclarubicin
Homoharringtonine
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Induction chemotherapy
Idarubicin
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Objective: To observe the efficacy and side effect of modified CHG regimen [( homoharringtonine(HHT),cytosine arabinoside(Ara-C) and granulocyte colony stimulating factor(G-CSF)]for treatment of the newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia(HAML). Methods: Twenty-three adult patients with HAML were treated with modified CHG regimen: HHT 2 mg /d intravenously; Ara-C 10mg /( m2·d) hypodermically once 12 hours for 14days; and G-CSF 300 μg /d hypodermically when WBC 10 × 109/L until absolute neutrophil count( ANC) ≥1. 5 ×109/L. Results: Fifteen cases(65. 2%) achieved complete remission(CR),2 cases(8. 7%) partial remission(PR),the overall response rate(OR) was 73. 9%. Two of them died and the early mortality was 8. 7%. The WBC counts decreased below 10 × 109/L necessitated 6(4 ~ 10) days of modified CHG treatments. The main adverse effect during the chemotherapy was myelosuppression,manifested as neutropenia with secondary infection and bleeding. Conclusions: The efficacy of modified CHG regimen for newly diagnosed adult patients with HAML is rather high and the side effects are controllable.
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To compare the efficacy and toxicity of 10 mg/m² or 8 mg/m² idarubicin (Ida) combined with cytarabine (IA"3+7"regimen) as induction chemotherapy for adult patients with newly diagnosed acute myeloid leukemia (AML).From June 2004 to October 2013, 335 adult AML (non acute promyelocytic leukemia) patients receiving the IA regimen as induction chemotherapy were enrolled, including 198 cases with 10 mg/m² Ida and 137 cases with 8 mg/m² Ida for 3 days. We compared the hematologic response, hematologic side effects and prognosis between the two regimens.Except for 4 early deaths, the complete remission (CR) rate after the first cycle of induction chemotherapy was 72.5%, 10.0% partial remission (PR) and 82.5% overall remission (OR) rate. The CR and OR rates were higher in the 10 mg/m² Ida group than the 8 mg/m² Ida group (CR: 78.9% vs 63.5%, P=0.003; OR: 88.2% vs 75.4%, P=0.007). Multivariate analysis showed that female, HGB≥100 g/L, FLT3-ITD mutation negative and 10 mg/m² Ida were favorable factors for CR. All patients presented cytopenias of grade Ⅳ. There was no differences on the recovery time of ANC≥0.5×10⁹/L and PLT≥20×10⁹/L after induction chemotherapy. Within a median follow-up of 14 (1-118) months, 98 (29.3%) patients relapsed, 92 (27.5%) died. The disease-free survival (DFS) and overall survival (OS) at 3 years were 53.2% and 58.9%, respectively. DFS and OS at 3-year were 34.2% and 37.4% in the chemotherapy cohort, 74.5% and 81.2% in the transplant cohort. 10 mg/m² Ida was an independent favorite factor for DFS (P=0.040) and OS (P=0.007).As compared to 8 mg/m², 10 mg/m² Ida significantly improved the CR, with the same extent of hematological side effects, and was an independent favorite factor for DFS and OS.
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Cytosine arabinoside (cytarabine or Ara-C) has been one of the cornerstones of treatment of acute myeloid leukemia since its approval in 1969. Standard induction therapy worldwide for all patients deemed fit for treatment (excluding those with acute promyelocytic leukemia) remains unchanged for over 40 years and consists of Ara-C administered by continuous infusion in combination with a topoisomerase II inhibitor (e.g., daunorubicin, idarubicin and mitoxantrone). Despite decades of clinical investigation, the optimum dose of both agents still remains unclear. Although higher doses of Ara-C have been shown to improve response rates, the elderly poorly tolerate these regimens. Resistance mechanisms also develop or may be present at diagnosis resulting in poor outcomes. Elacytarabine (CP-4055), an elaidic acid ester of Ara-C, has been developed using lipid vector technology in an attempt to overcome these limitations. Clinical data are encouraging, with evidence suggesting that this novel agent is circumventing resistance mechanisms but retaining the potent antileukemic efficacy of Ara-C.
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The purpose of this study was to assess the efficacy and toxicity of HAI regimen [(homoharringtonine 2.5 mg/(m(2)×d), days 1 - 7; cytarabine 150 mg/(m(2)×d), days 1 - 7; idarubicin 9 mg/(m(2)×d), days 1 - 7)] for induction treatment of newly diagnosed acute myeloid leukemia (AML) (except acute promyelocytic leukemia). 31 patients with newly diagnosed AML, aged 39 (14 - 58) years, were enrolled in this clinical study. The complete remission (CR) rate, especially after one course, the overall survival (OS) rate and relapse free survival (RFS) rate were estimated. The outcomes were compared between different prognostic groups according to World Health Organization (WHO) classification, genetics and initial WBC count. Safety was evaluated using standard WHO criteria. The results showed that 26 patients (84%) achieved CR after 1 course of induction. The CR rate for the patients with favorable, intermediate and unfavorable cytogenetics was 90%, 88% and 60% respectively. All 7 patients with a high initial WBC count (≥ 100×10(9)/L) obtained CR, while 19 out of 24 without a high initial WBC count obtained CR. With a median follow-up of 15(range 2-56) months, the estimated 3-year OS rate for all patients and the patients with CR was 44% and 52% respectively. The 3-year RFS rate was 51%. The patients receiving induction chemotherapy died of the chemotherapy. Profound myelosuppression was seen in all patients after the HAI induction with the median duration of neutropenia (ANC < 0.2×10(9)/L) of 16 (6 - 24) days. As the most common toxicity, severe infections (grade III-IV) involved in all the patients and the duration of febris was 6 (1 - 36) days. The incidence of septemia and invasive fungus infection were 19.4% and 45.2% respectively. The incidence of non-infection fever, increased glutamic-pyruvic transaminase (GPT), diarrhea, increased bilirubin and oral cavity mucositis were 6.5%, 6.5%, 3.2%, 3.2%, 3.2% respectively, as the more frequent severe non-hematological toxicities. It is concluded that HAI regimen is a high efficient induction schedule for the newly diagnosed AML, and archive the higher CR rate after one course than DNR/Ara-C standard induction regimen. Side effects are acceptable, except severe infection.
Idarubicin
Homoharringtonine
Induction chemotherapy
Regimen
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Objective:To observe the efficacy and side effect of low-dose homoharringtonine(HHT)and cytarabine(Ara-C)on the newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia(HAML). Method:Twenty-three patients with HAML were treated with low-dose HA regimen:HHT 2mg/d and Ara-C 10 mg/(m2·d),q12hfor 14days,granulocyte colony stimulating factor(G-CSF)300μg/d,ih,when WBC10× 109/L until absolute neutrophil count≥1.5×109/L.Result:Fifteen patients(65.2%)achieved complete remission,two cases(8.7%)achieved partial remission.Six cases(26.1%)had no response and 2of them died.The overall response rate was 73.9% and the early mortality was 8.7%.It took 6(4to 10)days after low-dose HA treatment when the WBC counts decreased below 10×109/L.The main adverse reaction during the chemotherapy was myelosuppression and manifested as infection(caused by neutropenia)and bleeding.Conclusion:The efficacy of low-dose HA on newly diagnosed adult HAML is higher and the side effect is controllable.
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Objective To explore the clinical efficacy and toxicity of idarubicin (IDA)-based IA regimen as induction chemotherapy in treating acute myeloid leukemia (AML) within different risk groups.Methods Data collected in 60 patients initially diagnosed and treated with one course of IA regimen were studied retrospectively.Results Efficacy were different for patients treatment with different prognosis after one course of IA chemotherapy,CR rates achieved in patients with favorable,intermediate and unfavorable prognosis were 83.3 ％ (10/12),73.1％ (19/26),59.1％ (13/22) respectively,PR rates were 16.7 ％ (2/12),19.2％ (5/26),13.6％ (3/22) while ORrateswere 100％ (12/12),92.3 ％ (24/26),72.7 ％ (15/22)respectively.After 2 years of follow-up,relapse free survival (RFS) rates were 100 ％ for patients with good prognosis,53.8 ％ for those with moderate prognosis,and 45.5 ％ for people with poor prognosis.The outcome showed that there were significant differences among these three group (P =0.042).Myelosuppression and infections due to neutropenia were the main adverse effects,and severe non-hematologic toxicities were not observed.Conclusion IA regimen as induction chemotherapy may be an efficacious and safe solution and achieve a higher CR rate and 2 years RFS rate for patients diagnosed as AML with good prognosis.Hematopoietic stem cell transplantation should be considered as soon as possible for patients with moderate or poor prognosis.
Key words:
Leukemia, myeloid, acute; Drug therapy, combination
Idarubicin
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Induction chemotherapy
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Objective To evaluate the efficacy and safety of the HAA regimen (homoharringtonine,cytarabine and aclarubicin) as induction chemotherapy in de novo acute myeloid leukemia (AML) .Methods The efficacy and safety of 236 de novo AML patients who received the HAA regimen as induction chemotherapy were retrospectively analyzed.The complete remission (CR) rate was assayed.Kaplan-Meier method was used to estimate overall survival (OS) and relapse free survival (RFS) ,and the differ-
Homoharringtonine
Aclarubicin
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Induction chemotherapy
Chemotherapy regimen
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Idarubicin
Homoharringtonine
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Induction chemotherapy
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Idarubicin
Daunorubicin
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Induction chemotherapy
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