EFFICACY OF ETOPOSIDE AND MITOXANTRONE IN PATIENTS WITH ACUTE MYELOGENOUS LEUKEMIA REFRACTORY TO STANDARD INDUCTION THERAPY AND INTERMEDIATE-DOSE CYTARABINE WITH AMSIDINE

Thirty-seven newly diagnosed patients with acute myeloid leukemia (AML ) who were not in complete remission (CR) after induction chemotherapy with cytarabine and daunorubicin followed by intermediate-dose cytara bine and amsacrine, were treated with mitoxantrone and etoposide in a prospective, open multicenter study. The aim was to examine the effica cy and the toxicity of mitoxantrone and etoposide in a patient populat ion with bad prognosis because of refractoriness to two standardized i nduction courses. Twelve patients attained CR (32.4%). Responders were found only among the patients with documented susceptibility (i.e. pa rtial remission) to the previous therapy. In responding patients the m edian remission duration and disease-free survival was 15+ months (ran ge 3-52+). Toxicity was mainly hematologic and characterized by prolon ged hypoplasia; one patient died in aplasia. Granulocytes and platelet s recovered unexpectedly early in six of 22 non-responders. This study suggests that AML patients refractory to two standardized chemotherap y courses can still attain a durable CR after an additional course, he re with mitoxantrone and etoposide, provided they show some responsive ness to the previously given cytostatic drugs.