A randomized trial of liposomal daunorubicin and cytarabine versus liposomal daunorubicin and topotecan with or without thalidomide as initial therapy for patients with poor prognosis acute myelogenous leukemia or myelodysplastic syndrome
✍ Scribed by Jorge Cortes; Hagop Kantarjian; Maher Albitar; Deborah Thomas; Stefan Faderl; Charles Koller; Guillermo Garcia-Manero; Francis Giles; Michael Andreeff; Susan O'Brien; Michael Keating; Elihu Estey
- Publisher
- John Wiley and Sons
- Year
- 2003
- Tongue
- English
- Weight
- 102 KB
- Volume
- 97
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Abstract
BACKGROUND
Because angiogenesis may play a role in the pathogenesis of acute myeloid leukemia (AML) and high‐risk myelodysplastic syndrome (MDS), and thalidomide (Th) has shown significant anti‐angiogenic activity, this study was designed to investigate the potential role of Th in the treatment of patients with AML and MDS and the possible role of a non–ara‐C‐containing regimen.
METHODS
Adults with AML or high‐risk MDS and cytogenetic abnormalities other than inv (16), t(8;21), ‐Y or ‐X were randomized to receive liposomal daunorubicin (DNX) and ara‐C (DA) or DNX and topotecan (DT). Within each arm, patients were randomized to receive chemotherapy alone (DA or DT) or with thalidomide (DATh or DTTh). Vascular endothelial growth factor (VEGF) plasma levels and microvascular density was measured before and after therapy. Eighty‐four patients (median age, 65 years; range, 27–84 years) were treated.
RESULTS
None of 11 patients treated with DT or DTTh responded and these arms were closed. Seventeen of 37 patients treated with DA and 15 of 36 treated with DATh achieved an early complete remission. Median complete response duration was 38 and 34 weeks (P = 0.57) and median survival 35 and 28 weeks (P = 0.15), respectively. Patients with high pretreatment VEGF levels had an inferior survival. There was no significant difference in the changes in VEGF levels or microvascular density after treatment in patients who did versus those who did not receive thalidomide.
CONCLUSIONS
The authors concluded that thalidomide in combination with chemotherapy does not result in clinical benefit in patients with AML or high‐risk MDS. Cancer 2003;97:1234–41. © 2003 American Cancer Society.
DOI 10.1002/cncr.11180