Treatment of therapy-related myeloid neoplasms with high-dose cytarabine/mitoxantrone followed by hematopoietic stem cell transplant

Abstract

Few clinical protocols have focused on patients with therapy-related myeloid neoplasms (t-MN). Therefore, we enrolled 32 patients with previously untreated t-MN on a clinical trial testing the effectiveness of a unified induction regimen of high-dose cytarabine and mitoxantrone. The complete remission (CR) rate was 66% (95% CI 47–81%) and the partial remission (PR) rate was 16% (95% CI 5–33%), for an overall response rate of 82%. Day 30 treatment mortality was 9% (3/32), and the most serious induction toxicity was cardiac dysfunction. Among the patients with CR, 13 (62%) received consolidation therapy using an allogeneic hematopoietic cell transplant (HCT), four (21%) received an autologous HCT, and three (16%) received further chemotherapy. We observed long-term disease-free survival in patients who received all three types of consolidation therapy. The remission induction of high-dose cytarabine and mitoxantrone for t-MN is a well-tolerated efficacious combination, which allows aggressive consolidation and long-term disease-free survival.

Keywords:

• Therapy-related myeloid neoplasm
• high-dose cytarabine
• mitoxantrone

Acknowledgements

The authors thank our participating patients and families for their willingness to contribute to our research, as well as John Anastasi, Jerome Dickstein, Sandeep Gurbuxani, Elizabeth Hyjek, and James W. Vardiman for performing hematopathologic analysis of bone marrow samples.

Declaration of interest: This work was supported, in part, by funds provided by the Cancer Research Foundation.