難治性急性骨髄性白血病患者に対するエトポシドおよびミトキサントロンによるサルベージ療法：後ろ向きコホート研究
Mehrzad Mirzania1, Ahmad Khajeh-Mehrizi1, Tahereh Yavari2
1Department of Hematology and Medical Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Acute myeloid leukemia (AML) presents significant treatment challenges, particularly in refractory or relapsed (R/R) cases. This study evaluates the efficacy and outcomes of the salvage chemotherapy regimen containing etoposide 100 mg/m2 and mitoxantrone 10 mg/m2, both on days 1-5 (EM) in non-M3 AML patients.
Methods:
In a retrospective cohort study, data from 2011 to 2021 were analyzed for adult non-M3 AML patients in a tertiary referral center. Patients who underwent EM salvage chemotherapy after induction failure were included. Exclusion criteria were patients who died during induction, remission with induction, or ineligible for salvage chemotherapy.
Results:
Out of 449 non-M3 AML patients, 41 (9.1%) received the EM regimen. Of these, 19 (46.3%) showed no response, 5 (12.2%) achieved partial remission (PR), and 17 (41.5%) attained complete remission (CR). The median overall survival (OS) for all patients was 6 months (95% CI 2.3-9.6), with 12, 24, and 36-month OS rates of 31%, 23%, and 15%, respectively. Patients achieving CR or PR had significantly better outcomes compared to refractory patients. Patients who did not receive hematopoietic stem cell transplantation (HSCT) had a median OS of 7 months, while it was not reached for those who did undergo HSCT. At 36 months, the OS rate was significantly higher in patients who underwent HSCT than in those who did not (71.4% vs. 8.3% P = 0.001).
Conclusions:
The EM regimen offers a potential pathway to remission for R/R non-M3 AML patients. However, the outcomes are heavily influenced by patient-specific factors and subsequent treatment strategies such as HSCT.
