A randomized trial of three novel regimens for recurrent acute myeloid leukemia demonstrates the continuing challenge of treating this difficult disease

Mark R. Litzow*, Xin V. Wang, Martin P. Carroll, Judith E. Karp, Rhett P. Ketterling, Yanming Zhang, Scott H. Kaufmann, Hillard M. Lazarus, Selina M. Luger, Elisabeth M. Paietta, Keith W. Pratz, Han Win Tun, Jessica K. Altman, Edward R. Broun, Witold B. Rybka, Jacob M. Rowe, Martin S. Tallman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

To improve the outcome of relapsed/refractory acute myeloid leukemia (AML), a randomized phase II trial of three novel regimens was conducted. Ninety patients were enrolled and were in first relapse or were refractory to induction/re-induction chemotherapy. They were randomized to the following regimens: carboplatin-topotecan (CT), each by continuous infusion for 5 days; alvocidib (formerly flavopiridol), cytarabine, and mitoxantrone (FLAM) in a timed sequential regimen; or sirolimus combined with mitoxantrone, etoposide, and cytarabine (S-MEC). The primary objective was attainment of a complete remission (CR). A Simon two-stage design was used for each of the three arms. The median age of the patients in the FLAM arm was older at 62 years compared with 55 years for the CT arm and the S-MEC arm. The overall response was 14% in the CT arm (5/35, 90% CI 7%-35%), 28% in the FLAM arm (10/36, 90% CI, 16%-43%), and 16% in the S-MEC arm (3/19, 90% CI, 4%-36%). There were nine treatment-related deaths, seven of which occurred in the FLAM arm with four of these in elderly patients. We conclude that the FLAM regimen had an encouraging response rate and should be considered for further clinical development but should be used with caution in elderly patients.

Original languageEnglish (US)
Pages (from-to)111-117
Number of pages7
JournalAmerican Journal of Hematology
Volume94
Issue number1
DOIs
StatePublished - Jan 2019

Funding

This study was conducted by the ECOG-ACRIN Cancer Research Group (Robert L. Comis, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs) and supported in part by Public Health Service Grants CA180820, CA180794, CA180790, CA180802, CA180853, CA189859, CA180795, CA180791, and from the National Cancer Institute, National Institutes of Health and the Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. The authors sincerely thank Ms. Denise P. Chase for her assistance with transcribing and editing the manuscript.

ASJC Scopus subject areas

  • Hematology

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