A phase III comparison of high dose ARA-C (HIDAC) versus HIDAC plus mitoxantrone in the treatment of first relapsed or refractory acute myeloid leukemia

The aim of this study is to determine whether the addition of mitoxantrone to high dose cytarabine improves the outcome of treatment in patients with relapsed or refractory acute myeloid leukemia (AML). One hundred and sixty- two eligible patients, 14-76 years of age, with AML either in first relapse or that failed to respond to initial remission induction therapy, with no CNS involvement were randomized to receive therapy with cytarabine 3 gm/M-2 IV over 2 h every 12 h for 12 doses on days 1-6 (Arm I) (HIDAC); or HIDAC plus mitoxantrone 10 mg/M-2 IV daily on days 7-9 (Arm II) (HIDAC + M). Pati ents achieving complete remission were treated with three courses of consol idation including HIDAC (Ara-C 3 gm/M-2 IV q 12 h days 1-3; 2 gm/M-2 over a ge 50) alone (ARM I) or with mitoxantrone (10 mg/M-2 IV day 1) (ARM II:). A mong 162 patients (81 HIDAC, 81 HIDAC + M) evaluated for induction toxicity , there were 10 (12%) induction deaths with HIDAC and 13 (17%) with HIDAC M (2-tailed P = 0.65). Most early deaths were due to infection and/or hemo rrhage. Among 162 patients evaluated for responses to induction therapy, 26 /81 (32%) HIDAC and 36/81 (44%) HIDAC + M patients achieved complete remiss ion (two-tailed P = 0.15). Although this difference was not statistically s ignificant in univariate analysis, it was after adjusting for the effects o f WBC and PMN percentage in multivariate analysis (P = 0.013). Median survi vals from study entry were 8 months (HIDAC) and 6 months (HIDAC + M); 2-tai led logrank P = 0.58. Among 48 patients registered for consolidation, the m edian disease-free survivals from that registration were 8 months with HIDA C and 11 months with HIDAC + M (P = 0.60). There were three treatment-relat ed deaths during consolidation (1 HIDAC, 2 HIDAC + M), all due to infection s. In this randomized trial, the addition of mitoxantrone to high-dose cyta rabine was associated with a trend toward a higher CR rate. There was less evidence for an advantage in disease-free or overall survival, although any such conclusion is limited by the size of the study. (C) 1999 Elsevier Sci ence Ltd. All rights reserved.