MITOXANTRONE AND CYTOSINE-ARABINOSIDE AS TREATMENT FOR ACUTE MYELOBLASTIC-LEUKEMIA IN OLDER PATIENTS

The majority of patients with acute myeloid leukemia (AML) are elderly , and their response to chemotherapy is poorer than that of younger pa tients. The combination of mitoxantrone (MTN) and cytosine arabinoside (Ara-C) is a possible alternative to an anthracycline/Ara-C combinati on for the treatment of AML in these patients. Of 52 older patients (> 59 years) referred over a 3.5-year period, 33 patients (age range 60- 78 years, median 67 years) received MTN and Ara-C as therapy for newly diagnosed AML. MTN was administered at a dose of 12 mg/m(2)/day, intr avenously, for 3 days (23 patients), or 10 mg/m(2)/day for 5 days (10 patients), and Ara-C at a dose of 100 mg/m(2) twice daily, intravenous ly, for 7 days. Complete remission (CR) was achieved in 16/33 patients (48%). The median remission duration was 6 months (range 1-37 months) . The median survival was 14 months for those who achieved CR compared with 9 months for those with resistant disease. Two patients remain i n first CR after 13 and 37 months, but three patients died whilst rece iving consolidation therapy. In selected elderly patients with AML, th e combination of MTN and Ara-C provides an acceptable alternative to a n anthracycline/Ara-C regimen, with a higher CR rate than historical c ontrols. However, the CR rate and remission duration remain low compar ed with those of younger patients, supporting the need to investigate new approaches to treatment in this population.