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Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis

Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free,...

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Autores principales: Kuron, David, Pohlmann, Alexander, Angenendt, Linus, Kessler, Torsten, Mesters, Rolf, Berdel, Wolfgang E., Stelljes, Matthias, Lenz, Georg, Schliemann, Christoph, Mikesch, Jan-Henrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9998561/
https://www.ncbi.nlm.nih.gov/pubmed/36749402
http://dx.doi.org/10.1007/s00277-023-05111-x
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author Kuron, David
Pohlmann, Alexander
Angenendt, Linus
Kessler, Torsten
Mesters, Rolf
Berdel, Wolfgang E.
Stelljes, Matthias
Lenz, Georg
Schliemann, Christoph
Mikesch, Jan-Henrik
author_facet Kuron, David
Pohlmann, Alexander
Angenendt, Linus
Kessler, Torsten
Mesters, Rolf
Berdel, Wolfgang E.
Stelljes, Matthias
Lenz, Georg
Schliemann, Christoph
Mikesch, Jan-Henrik
author_sort Kuron, David
collection PubMed
description Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free, amsacrine-based chemotherapy TAA (thioguanine, cytarabine, amsacrine) may be as effective as cytarabine/daunorubicin for induction therapy in these patients. In this systematic retrospective single-center analysis, we documented the outcome of 31 patients with significant cardiac comorbidities including coronary heart disease or cardiomyopathy receiving TAA as induction chemotherapy. Median (range) ejection fraction (EF) was 48% (30–67%) in this cohort. Patients with EF below 30% were considered unfit for intensive induction therapy. Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months respectively. Poor outcome was primarily related to a high early mortality rate within the first 30 days of therapy, mainly caused by infectious complications. TAA cannot be recommended as a substitute of standard induction for AML patients with significant concomitant cardiac disease. In the era of novel agents, alternative strategies (e.g., hypomethylating agents plus venetoclax) should be considered when anthracycline-based regimens are not suitable.
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spelling pubmed-99985612023-03-11 Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis Kuron, David Pohlmann, Alexander Angenendt, Linus Kessler, Torsten Mesters, Rolf Berdel, Wolfgang E. Stelljes, Matthias Lenz, Georg Schliemann, Christoph Mikesch, Jan-Henrik Ann Hematol Original Article Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free, amsacrine-based chemotherapy TAA (thioguanine, cytarabine, amsacrine) may be as effective as cytarabine/daunorubicin for induction therapy in these patients. In this systematic retrospective single-center analysis, we documented the outcome of 31 patients with significant cardiac comorbidities including coronary heart disease or cardiomyopathy receiving TAA as induction chemotherapy. Median (range) ejection fraction (EF) was 48% (30–67%) in this cohort. Patients with EF below 30% were considered unfit for intensive induction therapy. Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months respectively. Poor outcome was primarily related to a high early mortality rate within the first 30 days of therapy, mainly caused by infectious complications. TAA cannot be recommended as a substitute of standard induction for AML patients with significant concomitant cardiac disease. In the era of novel agents, alternative strategies (e.g., hypomethylating agents plus venetoclax) should be considered when anthracycline-based regimens are not suitable. Springer Berlin Heidelberg 2023-02-07 2023 /pmc/articles/PMC9998561/ /pubmed/36749402 http://dx.doi.org/10.1007/s00277-023-05111-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Kuron, David
Pohlmann, Alexander
Angenendt, Linus
Kessler, Torsten
Mesters, Rolf
Berdel, Wolfgang E.
Stelljes, Matthias
Lenz, Georg
Schliemann, Christoph
Mikesch, Jan-Henrik
Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title_full Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title_fullStr Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title_full_unstemmed Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title_short Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis
title_sort amsacrine-based induction therapy in aml patients with cardiac comorbidities: a retrospective single-center analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9998561/
https://www.ncbi.nlm.nih.gov/pubmed/36749402
http://dx.doi.org/10.1007/s00277-023-05111-x
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