Elderly do benefit from induction chemotherapy: High dose mitoxantrone based ( “5+1”) induction chemotherapy regimen in newly diagnosed acute myeloid leukemia
An intensive “5+1” regimen, which included bolus high dose cytarabine at 3gm/m2 once daily over three hours on days 1 to 5 and high dose mitoxantrone (HDM) 80mg/m2 on day 2, was evaluated in 101 consecutively treated newly diagnosed Acute Myeloid Leukemia (AML) patients at a single center since 2009. The median age was 65 (range 18 ‐90) years. The 4 and 8‐week mortality in our cohort was 3/101 (2.9%) and 7/99 (7%) respectively. The overall response (CR + CRi) was 76.2% (77/101). The median overall survival stratified by age group=70 years were 56, 31 and 9 months respectively (log ‐rank, p=0.02). 51.7% (45/84) of patients with intermediate/adverse risk category proceeded to ASCTs. Among these 84 patients, the percentage of patients able to proceed to transplant in age groups
Because of their inherent chemoresistance, relapsed/refractory (R/R) myeloid malignancies remain a therapeutic challenge. For patients with primary refractory acute myeloid leukemia (AML) treated with another course of chemotherapy, the median survival is less than 6 months, and the 1-year overall survival is under 20%1,2. Regarding high-risk myelodysplastic syndrome (MDS), standard therapies involve a hypomethylating agent, to be continued as long as the patient responds3. In case of failure, median survival is also less than 6 months4.
J Cancer Res Clin Oncol. 2021 Jul 23. doi: 10.1007/s00432-021-03733-0. Online ahead of print.ABSTRACTBACKGROUND: Acute myeloid leukemia (AML) with antecedent hematological disease (s-AML) and treatment-related AML (t-AML) predicts poor prognosis. Intensive treatment protocols of those high-risk patients should consider allogeneic stem cell transplantation (allo-HSCT) in first complete remission (CR). Despite allo-HSCT, relapse rate remains high. Induction chemotherapy with liposomal cytarabine and daunorubicin (CPX-351) has been approved for patients with AML with myeloid-related changes (AML-MRC) or t-AML based on improve...
In patients with acute myeloid leukemia (AML), the development of recurrent disease after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with a dismal prognosis. Commonly used strategies such as the withdrawal of immunosuppressive agents, the use of targeted molecules or chemotherapy, donor lymphocyte infusion (DLI), or a second transplant (HSCT2) can benefit only the selected few. Therefore, it is critical to identify subsets of patients who derive the most benefit from a specific salvage approach.
Leucocyte kinetics and PCR results in our patients during hospitalization for conditioning chemotherapy for allogeneic hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). AbstractDespite severe immunosuppression due to conditioning chemotherapy for acute myeloid leukemia, COVID-19 did not lead to clinical deterioration or death, thus raising the question of the impact of immunosuppressive treatment on clinical course evolution.
AbstractThe study aim was to determine the benefit of the measurement of serum caspase-cleaved cytokeratin-18 (CK-18) fragment as a prognostic marker of febrile neutropenia (FN) in hematological patients. The study population consisted of 86 consecutive patients with FN who received intensive chemotherapy for hematological malignancy at the adult hematology ward of Kuopio University Hospital. Twenty-three patients (27%) had acute myeloid leukemia, and 63 patients (73%) were autologous stem cell transplant recipients. Serum caspase-cleaved CK-18 fragment M30, C-reactive protein (CRP) and procalcitonin (PCT) were measured at...
This article reviews the data for existing therapeutic options for patients with AML-MRC and the emerging therapies undergoing clinical trial development for this patient population.Expert opinion: The development of CPX-351 as a more effective induction therapeutic backbone for patients with AML-MRC presents an opportunity to investigate novel combination regimens in order to further improve outcomes. Promising emerging therapeutic modalities include immunotherapeutic strategies, small-molecule inhibitors and targeted agents. Unfortunately, there have been few clinical trials focusing on patients with AML-MRC with relianc...
ConclusionsVenetoclax monotherapy seems not enough to control the disease progression under CNS involvement and other treatments should be investigated.
CONCLUSIONS: Oral complaints significantly decrease the patients' quality of life during the transplantation and may lead to premature termination of the treatment. As the number of transplantations in patients with acute myeloid leukemia increases, further investigations of oral complaints and symptoms induced by the disease itself and by the therapeutic approaches are required.PMID:34162819 | DOI:10.4317/medoral.24647