Mitoxantrone, Etoposide, and Intermediate-Dose Cytosine Arabinoside (MEC): An Effective Regimen for Refractory Acute Myeloid Leukemia

Abstract

Treatment of acute myeloid leukemia (AML) frequently induces complete remission (CR) with initial induction chemotherapy. However, long-term disease-free survival is achieved in only a minority of patients, since the majority ultimately relapse [1]. The prognosis of patients who fail to achieve an initial CR or who experience recurrence of their leukemia remains dismal. Results of salvage therapy have been generally disappointing with low response rates and occasional long-term survivors in most studies [2]. Recently, we reported that a combination of intermediate-dose cytosine arabinoside (Ara-C) and mitoxantrone could induce CR in 24/36 (67%) patients with advanced AML, without undue toxicity [3]. Responses were observed in 85% of patients whose initial remission lasted for more than 6 months, but in only 28% and 33% of those with primary refractory disease and shorter remission duration, respectively.