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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,...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2023
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Materias: | |
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. |
format | Online Article Text |
id | pubmed-9998561 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
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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