Continuous sequential infusion of fludarabine and cytarabine for elderly patients with acute myeloid leukaemia secondary to a previously diagnosed myelodysplastic syndrome

✍ Scribed by Felicetto Ferrara; Salvatore Palmieri; Tiziana Izzo; Clelia Criscuolo; Cira Riccardi

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 217 KB
• Volume: 28
• Category: Article
• ISSN: 0278-0232
• DOI: 10.1002/hon.943

✦ Synopsis

Acute myeloid leukaemia (AML) secondary to myelodysplastic syndrome (MDS) is characterized by poor prognosis, namely in older patients. The combination of fludarabine (F) with cytarabine (ARA-C) AE G-CSF was proven as effective in patients with poor risk AML. The efficacy and toxicity of a regimen including F þARA-C as sequential continuous infusion (CI-FLA) in 64 untreated patients aged >60 years, in which AML arose after a previous MDS, was investigated. Median age was 67 years (61-81). In patients achieving CR, an additional course, followed by G-CSF to mobilize CD34þ cells and subsequent autologous stem cell transplantation (ASCT) were programmed. Overall, 43 patients (67%) achieved complete remission (CR). There were 10 induction deaths (16%), while 11 patients (17%) were refractory to induction treatment. Thirty-four patients (79% of remitters) were eligible for the consolidation and 30 were monitorized for the mobilization of CD34þ cells, collection being successful in 20 of them (67%). Median number of CD34þ cells/kg collected was 6.8 Â 10E6. Thirteen patients (20% of the whole population) received ASCT. Median disease free survival (DFS) and overall survival (OS) were 10 and 9 months, respectively. Survival at 5 years is projected to 15%. The only parameter significantly related to either DFS duration or OS duration was unfavourable cytogenetics, which did significantly influence also CR achievement. CI-FLA is effective in elderly patients with AML secondary to previously diagnosed MDS. Best results are achievable in the subgroup of patients with diploid karyotype.