Mitoxantrone and cytarabine induction, high-dose cytarabine, and etoposide intensification for pediatric patients with relapsed or refractory acute myeloid leukemia: Children's Cancer Group Study 2951

Robert J. Wells, Mary T. Adams, Todd A. Alonzo, Robert J. Arceci, Jonathan Buckley, Allen B. Buxton, Kathryn Dusenbery, Alan Gamis, Margaret Masterson, Terry Vik, Phyllis Warkentin, James A. Whitlock

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Purpose: To evaluate the response rate, survival, and toxicity of mitoxantrone and cytarabine induction, high-dose cytarabine and etoposide intensification, and further consolidation/maintenance therapies, including bone marrow transplantation, in children with relapsed, refractory, or secondary acute myeloid leukemia (AML). To evaluate response to 2-chlorodeoxyadenosine (2-CDA) and etoposide (VP-16) in patients who did not respond to mitoxantrone and cytarabine. Patients and Methods: Patients with relapsed/refractory AML (n = 101) and secondary AML (n = 13) were entered. Results: Mitoxantrone and cytarabine induction achieved a remission rate of 76% for relapsed/refractor/ patients and 77% for patients with secondary AML, with a 3% induction mortality rate. Cytarabine and etoposide intensification exceeded the acceptable toxic death rate of 10%. The response rate of 2-CDA/VP-16 was 8%. Two-year overall survival was estimated at 24% and was better than historical control data. Patients with secondary AML had similar outcomes to relapsed or refractory patients. Initial remission longer than 1 year was the most important prognostic factor for patients with primary AML (2-year survival rate, 75%), whereas for patients with primary AML, with less than 12 months of initial remission, survival was 13% and was similar to that of refractory patients (6%). Conclusion: Mitoxantrone and cytarabine induction is effective with reasonable toxicity in patients with relapsed/ refractory or secondary AML. The cytarabine and etoposide intensification regimen should be abandoned because of toxicity. Patients with relapsed AML with initial remissions longer than 1 year have a relatively good prognosis.

Original languageEnglish (US)
Pages (from-to)2940-2947
Number of pages8
JournalJournal of Clinical Oncology
Issue number15
StatePublished - Aug 1 2003


ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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