Cyclophosphamide combined with mitoxantrone and cytarabine is an effective salvage regimen for patients with acute myeloid leukemia who experienced primary induction failure or relapse

Abstract

Salvage regimens containing mitoxantrone have been successfully used for the treatment of primary induction failure or relapsed acute myeloid leukemia. However, the combination of cyclophosphamide with mitoxantrone and cytarabine (MAC) has never been assessed in these patients. A total of 91 patients, including patients with primary induction failure (n=44) and relapsed (n=47), were treated with a salvage MAC regimen, which consisted of mitoxantrone, cytarabine and cyclophosphamide. The overall complete remission rate was 74.7 (68/91) and 72.7% (32/44) for primary induction failure, and 76.6% (36/47) for relapsed patients. The overall survival rate and disease-free survival rate were 72.1 and 59.7% at 1 year, 42.9 and 47.1% at 3 years, and 36.7 and 43.0% at 5 years, respectively. Only one patient succumbed to mortality during induction therapy. The toxicity level was acceptable. Therefore, the present study demonstrated that MAC is a highly effective and well-tolerated regimen for salvage in patients experiencing primary induction failure or relapse. This treatment significantly improved the prognosis.

Keywords: MAC regimen; acute myeloid leukemia; primary induction failure; relapse.

Figure 1.

Overall survival for the entire study population. The overall survival at 1, 3 and 5 years for the entire study population were 72.1, 42.9 and 36.7%, respectively.

Figure 2.

Overall survival for the CR and NR groups. For patients with CR (n=68) or not (n=23), 1 and 3 year overall survival rates were 83.3, vs. 32.7% (P<0.001) and 57.3, vs. 10.3%, respectively. CR, complete remission; NR, non-remission.

Figure 3.

Disease free survival for the entire study population. For the entire cohort, the 1 and 3 year disease-free survival rates were 48.1, vs. 38.0% respectively. The median disease-free survival rate was 10 months.

Figure 4.

Disease free survival for the complete remission group. For patients exhibiting complete remission following the mitoxantrone and cytarabine regimen, the disease-free survival rate at 1, 3 and 5 years was 59.7, 47.1 and 43%, respectively.