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Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study

DNA methyltransferase inhibitors sensitize leukemia cells to chemotherapeutics. We therefore conducted a phase 1/2 study of mitoxantrone, etoposide, and cytarabine following “priming” with 5-10 days of decitabine (dec/MEC) in 52 adults (median age 55 [range: 19-72] years) with relapsed/refractory ac...

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Autores principales: Halpern, Anna B., Othus, Megan, Huebner, Emily M., Buckley, Sarah A., Pogosova-Agadjanyan, Era L., Orlowski, Kaysey F., Scott, Bart L., Becker, Pamela S., Hendrie, Paul C., Chen, Tara L., Percival, Mary-Elizabeth M., Estey, Elihu H., Stirewalt, Derek L., Walter, Roland B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709258/
https://www.ncbi.nlm.nih.gov/pubmed/28555084
http://dx.doi.org/10.1038/leu.2017.165
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author Halpern, Anna B.
Othus, Megan
Huebner, Emily M.
Buckley, Sarah A.
Pogosova-Agadjanyan, Era L.
Orlowski, Kaysey F.
Scott, Bart L.
Becker, Pamela S.
Hendrie, Paul C.
Chen, Tara L.
Percival, Mary-Elizabeth M.
Estey, Elihu H.
Stirewalt, Derek L.
Walter, Roland B.
author_facet Halpern, Anna B.
Othus, Megan
Huebner, Emily M.
Buckley, Sarah A.
Pogosova-Agadjanyan, Era L.
Orlowski, Kaysey F.
Scott, Bart L.
Becker, Pamela S.
Hendrie, Paul C.
Chen, Tara L.
Percival, Mary-Elizabeth M.
Estey, Elihu H.
Stirewalt, Derek L.
Walter, Roland B.
author_sort Halpern, Anna B.
collection PubMed
description DNA methyltransferase inhibitors sensitize leukemia cells to chemotherapeutics. We therefore conducted a phase 1/2 study of mitoxantrone, etoposide, and cytarabine following “priming” with 5-10 days of decitabine (dec/MEC) in 52 adults (median age 55 [range: 19-72] years) with relapsed/refractory acute myeloid leukemia (AML) or other high-grade myeloid neoplasms. During dose escalation in cohorts of 6-12 patients, all dose levels were well-tolerated. As response rates appeared similar with 7 and 10-days of decitabine, a 7-day course was defined as the recommended phase 2 dose (RP2D). Among 46 patients treated at/above the RP2D, 10 (22%) achieved a complete remission (CR), 8 without measurable residual disease; five additional patients achieved CR with incomplete platelet recovery, for an overall response rate of 33%. Seven patients (15%) died within 28 days of treatment initiation. Infection/neutropenic fever, nausea, and mucositis were the most common adverse events. While the CR rate compared favorably to a matched historic control population (observed/expected CR ratio=1.77), CR rate and survival were similar to two contemporary salvage regimens used at our institution (G-CLAC and G-CLAM). Thus, while meeting the pre-specified efficacy goal, we found no evidence that dec/MEC is substantially better than other cytarabine-based regimens currently used for relapsed/refractory AML.
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spelling pubmed-57092582017-12-01 Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study Halpern, Anna B. Othus, Megan Huebner, Emily M. Buckley, Sarah A. Pogosova-Agadjanyan, Era L. Orlowski, Kaysey F. Scott, Bart L. Becker, Pamela S. Hendrie, Paul C. Chen, Tara L. Percival, Mary-Elizabeth M. Estey, Elihu H. Stirewalt, Derek L. Walter, Roland B. Leukemia Article DNA methyltransferase inhibitors sensitize leukemia cells to chemotherapeutics. We therefore conducted a phase 1/2 study of mitoxantrone, etoposide, and cytarabine following “priming” with 5-10 days of decitabine (dec/MEC) in 52 adults (median age 55 [range: 19-72] years) with relapsed/refractory acute myeloid leukemia (AML) or other high-grade myeloid neoplasms. During dose escalation in cohorts of 6-12 patients, all dose levels were well-tolerated. As response rates appeared similar with 7 and 10-days of decitabine, a 7-day course was defined as the recommended phase 2 dose (RP2D). Among 46 patients treated at/above the RP2D, 10 (22%) achieved a complete remission (CR), 8 without measurable residual disease; five additional patients achieved CR with incomplete platelet recovery, for an overall response rate of 33%. Seven patients (15%) died within 28 days of treatment initiation. Infection/neutropenic fever, nausea, and mucositis were the most common adverse events. While the CR rate compared favorably to a matched historic control population (observed/expected CR ratio=1.77), CR rate and survival were similar to two contemporary salvage regimens used at our institution (G-CLAC and G-CLAM). Thus, while meeting the pre-specified efficacy goal, we found no evidence that dec/MEC is substantially better than other cytarabine-based regimens currently used for relapsed/refractory AML. 2017-05-30 2017-12 /pmc/articles/PMC5709258/ /pubmed/28555084 http://dx.doi.org/10.1038/leu.2017.165 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Halpern, Anna B.
Othus, Megan
Huebner, Emily M.
Buckley, Sarah A.
Pogosova-Agadjanyan, Era L.
Orlowski, Kaysey F.
Scott, Bart L.
Becker, Pamela S.
Hendrie, Paul C.
Chen, Tara L.
Percival, Mary-Elizabeth M.
Estey, Elihu H.
Stirewalt, Derek L.
Walter, Roland B.
Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title_full Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title_fullStr Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title_full_unstemmed Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title_short Mitoxantrone, Etoposide, and Cytarabine (MEC) Following Epigenetic Priming with Decitabine in Adults with Relapsed/Refractory Acute Myeloid Leukemia or Other High-Grade Myeloid Neoplasms: A Phase 1/2 Study
title_sort mitoxantrone, etoposide, and cytarabine (mec) following epigenetic priming with decitabine in adults with relapsed/refractory acute myeloid leukemia or other high-grade myeloid neoplasms: a phase 1/2 study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709258/
https://www.ncbi.nlm.nih.gov/pubmed/28555084
http://dx.doi.org/10.1038/leu.2017.165
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