Treatment of therapy-related myeloid neoplasms with high-dose cytarabine/mitoxantrone followed by hematopoietic stem cell transplant

Few clinical protocols have focused on patients with therapy-related myeloid neoplasms (t-MN). Therefore, we enrolled 32 patients with previously untreated t-MN on a clinical trial testing the effectiveness of a unified induction regimen of high-dose cytarabine and mitoxantrone. The complete remission (CR) rate was 66 (95 CI 4781) and the partial remission (PR) rate was 16 (95 CI 533), for an overall response rate of 82. Day 30 treatment mortality was 9 (3/32), and the most serious induction toxicity was cardiac dysfunction. Among the patients with CR, 13 (62) received consolidation therapy using an allogeneic hematopoietic cell transplant (HCT), four (21) received an autologous HCT, and three (16) received further chemotherapy. We observed long-term disease-free survival in patients who received all three types of consolidation therapy. The remission induction of high-dose cytarabine and mitoxantrone for t-MN is a well-tolerated efficacious combination, which allows aggressive consolidation and long-term disease-free survival.