THERAPY OF UNTREATED ACUTE MYELOID-LEUKEMIA IN THE ELDERLY - REMISSION-INDUCTION USING A NON-CYTARABINE-CONTAINING REGIMEN OF MITOXANTRONE PLUS ETOPOSIDE

Purpose: The University of Manitoba Adult Acute Leukemia Study Group s ought to examine the safety, efficacy, and impact on quality of life o f a non-cytarabine-containing remission-induction regimen followed by intermediate-dose cytarabine (IDARA-C) postremission therapy for the m anagement of untreated acute myeloid leukemia (AML) in patients age 60 to 80 years. Patients and Methods: Eligible patients received mitoxan trone 10 mg/m(2) and etoposide 100 mg/m(2) on days 1 to 5. Complete re mitters received a single course of cytarabine 0.5 g/m(2) every 12 hou rs on days 1 to 6. Cytogenetic and immunophenotyping studies were perf ormed at diagnosis and were examined for prognostic importance. The Fu nctional Living Index-Cancer (FLI-C) was used in the longitudinal asse ssment of quality of life. Results: A total of 37 (55%) of 67 eligible patients achieved remission, 34 (92%) of whom did so with a single co urse. The induction mortality rate was 12%. The median disease-free an d overall survival times were 8.4 and 9.2 months, respectively. CD34 s tem-cell phenotype, poor performance status, and high cytogenetic comp lexity score were independent covariates of failure to achieve remissi on. Very complex karyotype combined with CD34 stem-cell phenotype to p redict induction death in 67% of cases (P = .0003). Cytotoxic therapy- related gut epithelial damage was maximal during weeks 2 and 3 of ther apy. Complete remitters and partial responders exhibited significantly improved global FLI-C scores following completion of therapy. Conclus ion: Mitoxantrone plus etoposide was an effective and well-tolerated f irst-line induction regimen for AML in the elderly that should be stud ied further in comparison to the standard cytarabine/anthracycline-bas ed therapy. (C) 1996 by American Society of Clinical Oncology.