Continuous-Infusion Carboplatin in Combination with Idarubicin or Mitoxantrone for High-Risk Acute Myeloid Leukemia: A Randomised Phase II Study

• Published in: Leukemia & lymphoma 1999, Vol.36 (1-2), p.45-55
• Main Authors: Belhabri, Amine, Thomas, Xavier, Troncy, Jacques, Assouline, David, Michallet, Mauricette, Wattel, Eric, Tigaud, Jean Dominique, Blanc, Michel, Fiére, Denis, Archimbaud, Eric
• Format: Article
• Language: English
• Subjects: acute rnyeloid leukemia; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; carboplatin; Carboplatin - administration & dosage; Female; Humans; idarubicin; Idarubicin - administration & dosage; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - mortality; Male; Middle Aged; mitoxantrone; Mitoxantrone - administration & dosage; relapse; resistance; Survival Rate
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428199909145948

Fifty-three patients of median age 66 years (39 patients > 60 yrs), including 5 with FAB unclassified or secondary acute myeloid leukemia (AML) at diagnosis, 14 with resistant AML, 19 in first and 15 in subsequent relapse, were treated with carboplatin (CBP), 200 mg/m2/day, as a continuous infusion, (days 3 to 7) with mitoxantrone (MIT) or idarubicin (IDA), (12mg/m2/day) as an IV bolus, on days 1 to 3. Results were evaluated after one induction course. Overall, 15 patients (28% [95% confidence interval (CI), 17-42%], 8/28 with IDA and 7/25 with MIT) achieved complete remission (CR). There was no statistical difference between IDA and MIT arms. Fourty-nine percent (95% CI, 35-63%) had resistant disease (53% IDA versus 44% MIT respectively) and 23% (95% CI, 12-36%) died from toxicity (18% IDA versus 28% MIT). Median durations of neutrophils less than 0.5 × 109/1 and platelet counts less than 20 × 109fl were 32 and 32 days respectively in the IDA arm and 31 and 26 days respectively in the MIT arm. Severe toxicity included infections (45%), diarrhea (21%), bleeding (9%), vomiting (7%), hyperbilirubinemia (6%). mucositis (4%) (no statistical difference was seen between both arms). Nephrotoxicity was observed in only one case in the IDA arm. Cardiac toxicity included reversible pulmonary oedema in one patient in the IDA arm. No severe oto-toxicity was noted. CR patients received maintenance courses with 3 days of CBP and one day of IDA or MIT. Median survival was 2 months (range, 1-30+ months) and 2.5 months (range, 0.5-19.5 months), and median disease-free survival (DFS) 2 months (range, 1-30′ months) and 2.5 months (range, 1-14 months) in the JDA and MIT arms respectively. We conclude that CBP at a cumulative dosage of 1 g/m2 together with intercalating agents (IDA/MIT) has antileukemic efficacy in elderly patients.