Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia: Children's Cancer Group Study 2951

Robert J. Wells, Mary T. Adams, Todd A. Alonzo, Robert J. Arceci, Jonathan Buckley, Allen B. Buxton, Kathryn Dusenbery, Alan Gamis, Margaret Masterson, Terry Vik, Phyllis Warkentin, James A. Whitlock

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the response rate, survival, and toxicity of mitoxantrone and cytarabine induction, high-dose cytarabine and etoposide intensification, and further consolidation/maintenance therapies, including bone marrow transplantation, in children with relapsed, refractory, or secondary acute myeloid leukemia (AML). To evaluate response to 2-chlorodeoxyadenosine (2-CDA) and etoposide (VP-16) in patients who did not respond to mitoxantrone and cytarabine. Patients and Methods: Patients with relapsed/refractory AML (n = 101) and secondary AML (n = 13) were entered. Results: Mitoxantrone and cytarabine induction achieved a remission rate of 76% for relapsed/refractor/ patients and 77% for patients with secondary AML, with a 3% induction mortality rate. Cytarabine and etoposide intensification exceeded the acceptable toxic death rate of 10%. The response rate of 2-CDA/VP-16 was 8%. Two-year overall survival was estimated at 24% and was better than historical control data. Patients with secondary AML had similar outcomes to relapsed or refractory patients. Initial remission longer than 1 year was the most important prognostic factor for patients with primary AML (2-year survival rate, 75%), whereas for patients with primary AML, with less than 12 months of initial remission, survival was 13% and was similar to that of refractory patients (6%). Conclusion: Mitoxantrone and cytarabine induction is effective with reasonable toxicity in patients with relapsed/ refractory or secondary AML. The cytarabine and etoposide intensification regimen should be abandoned because of toxicity. Patients with relapsed AML with initial remissions longer than 1 year have a relatively good prognosis.

Original languageEnglish (US)
Pages (from-to)2940-2947
Number of pages8
JournalJournal of Clinical Oncology
Volume21
Issue number15
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

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Mitoxantrone
Cytarabine
Etoposide
Acute Myeloid Leukemia
Pediatrics
Neoplasms
Cladribine
Survival Rate
Survival
Mortality
Poisons
Bone Marrow Transplantation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia : Children's Cancer Group Study 2951. / Wells, Robert J.; Adams, Mary T.; Alonzo, Todd A.; Arceci, Robert J.; Buckley, Jonathan; Buxton, Allen B.; Dusenbery, Kathryn; Gamis, Alan; Masterson, Margaret; Vik, Terry; Warkentin, Phyllis; Whitlock, James A.

In: Journal of Clinical Oncology, Vol. 21, No. 15, 01.08.2003, p. 2940-2947.

Research output: Contribution to journalArticle

Wells, Robert J. ; Adams, Mary T. ; Alonzo, Todd A. ; Arceci, Robert J. ; Buckley, Jonathan ; Buxton, Allen B. ; Dusenbery, Kathryn ; Gamis, Alan ; Masterson, Margaret ; Vik, Terry ; Warkentin, Phyllis ; Whitlock, James A. / Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia : Children's Cancer Group Study 2951. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 15. pp. 2940-2947.
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title = "Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia: Children's Cancer Group Study 2951",
abstract = "Purpose: To evaluate the response rate, survival, and toxicity of mitoxantrone and cytarabine induction, high-dose cytarabine and etoposide intensification, and further consolidation/maintenance therapies, including bone marrow transplantation, in children with relapsed, refractory, or secondary acute myeloid leukemia (AML). To evaluate response to 2-chlorodeoxyadenosine (2-CDA) and etoposide (VP-16) in patients who did not respond to mitoxantrone and cytarabine. Patients and Methods: Patients with relapsed/refractory AML (n = 101) and secondary AML (n = 13) were entered. Results: Mitoxantrone and cytarabine induction achieved a remission rate of 76{\%} for relapsed/refractor/ patients and 77{\%} for patients with secondary AML, with a 3{\%} induction mortality rate. Cytarabine and etoposide intensification exceeded the acceptable toxic death rate of 10{\%}. The response rate of 2-CDA/VP-16 was 8{\%}. Two-year overall survival was estimated at 24{\%} and was better than historical control data. Patients with secondary AML had similar outcomes to relapsed or refractory patients. Initial remission longer than 1 year was the most important prognostic factor for patients with primary AML (2-year survival rate, 75{\%}), whereas for patients with primary AML, with less than 12 months of initial remission, survival was 13{\%} and was similar to that of refractory patients (6{\%}). Conclusion: Mitoxantrone and cytarabine induction is effective with reasonable toxicity in patients with relapsed/ refractory or secondary AML. The cytarabine and etoposide intensification regimen should be abandoned because of toxicity. Patients with relapsed AML with initial remissions longer than 1 year have a relatively good prognosis.",
author = "Wells, {Robert J.} and Adams, {Mary T.} and Alonzo, {Todd A.} and Arceci, {Robert J.} and Jonathan Buckley and Buxton, {Allen B.} and Kathryn Dusenbery and Alan Gamis and Margaret Masterson and Terry Vik and Phyllis Warkentin and Whitlock, {James A.}",
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TY - JOUR

T1 - Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia

T2 - Children's Cancer Group Study 2951

AU - Wells, Robert J.

AU - Adams, Mary T.

AU - Alonzo, Todd A.

AU - Arceci, Robert J.

AU - Buckley, Jonathan

AU - Buxton, Allen B.

AU - Dusenbery, Kathryn

AU - Gamis, Alan

AU - Masterson, Margaret

AU - Vik, Terry

AU - Warkentin, Phyllis

AU - Whitlock, James A.

PY - 2003/8/1

Y1 - 2003/8/1

N2 - Purpose: To evaluate the response rate, survival, and toxicity of mitoxantrone and cytarabine induction, high-dose cytarabine and etoposide intensification, and further consolidation/maintenance therapies, including bone marrow transplantation, in children with relapsed, refractory, or secondary acute myeloid leukemia (AML). To evaluate response to 2-chlorodeoxyadenosine (2-CDA) and etoposide (VP-16) in patients who did not respond to mitoxantrone and cytarabine. Patients and Methods: Patients with relapsed/refractory AML (n = 101) and secondary AML (n = 13) were entered. Results: Mitoxantrone and cytarabine induction achieved a remission rate of 76% for relapsed/refractor/ patients and 77% for patients with secondary AML, with a 3% induction mortality rate. Cytarabine and etoposide intensification exceeded the acceptable toxic death rate of 10%. The response rate of 2-CDA/VP-16 was 8%. Two-year overall survival was estimated at 24% and was better than historical control data. Patients with secondary AML had similar outcomes to relapsed or refractory patients. Initial remission longer than 1 year was the most important prognostic factor for patients with primary AML (2-year survival rate, 75%), whereas for patients with primary AML, with less than 12 months of initial remission, survival was 13% and was similar to that of refractory patients (6%). Conclusion: Mitoxantrone and cytarabine induction is effective with reasonable toxicity in patients with relapsed/ refractory or secondary AML. The cytarabine and etoposide intensification regimen should be abandoned because of toxicity. Patients with relapsed AML with initial remissions longer than 1 year have a relatively good prognosis.

AB - Purpose: To evaluate the response rate, survival, and toxicity of mitoxantrone and cytarabine induction, high-dose cytarabine and etoposide intensification, and further consolidation/maintenance therapies, including bone marrow transplantation, in children with relapsed, refractory, or secondary acute myeloid leukemia (AML). To evaluate response to 2-chlorodeoxyadenosine (2-CDA) and etoposide (VP-16) in patients who did not respond to mitoxantrone and cytarabine. Patients and Methods: Patients with relapsed/refractory AML (n = 101) and secondary AML (n = 13) were entered. Results: Mitoxantrone and cytarabine induction achieved a remission rate of 76% for relapsed/refractor/ patients and 77% for patients with secondary AML, with a 3% induction mortality rate. Cytarabine and etoposide intensification exceeded the acceptable toxic death rate of 10%. The response rate of 2-CDA/VP-16 was 8%. Two-year overall survival was estimated at 24% and was better than historical control data. Patients with secondary AML had similar outcomes to relapsed or refractory patients. Initial remission longer than 1 year was the most important prognostic factor for patients with primary AML (2-year survival rate, 75%), whereas for patients with primary AML, with less than 12 months of initial remission, survival was 13% and was similar to that of refractory patients (6%). Conclusion: Mitoxantrone and cytarabine induction is effective with reasonable toxicity in patients with relapsed/ refractory or secondary AML. The cytarabine and etoposide intensification regimen should be abandoned because of toxicity. Patients with relapsed AML with initial remissions longer than 1 year have a relatively good prognosis.

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U2 - 10.1200/JCO.2003.06.128

DO - 10.1200/JCO.2003.06.128

M3 - Article

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AN - SCOPUS:0042386631

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