Mac In The Treatment Of The Initial Induced Without Remission And Relapse Of Acute Myeloid Leukemia

ObjectiveTo investigate the efficacy and safety of MAC regimen for patients with acute myeloid leukemia (AML) who experienced primary induction failure (non remission, NR) or relapse.MethodsEighty-one patients with acute myeloid leukemia, including patients with primary induction failure or experienced relapse, recieved MAC regimen (mitozantrone, cytarabine, cyclophosphamide) for further therapy. To investigate the efficacy and safety of this regimen, clinical data were analyzed, including complete remission (CR) rate, disease free survival (DFS) rate, overall survival (OS) rate, hematological toxicity and non-hematological toxicities. Correlation of prognosis to white blood cell count, FLT3 phenotype and cytogenetic risk groups were analyzed. The R software (R 2.10.1) was used for statistics.Results1. The study cohort demonstrated a CR rate of 75.3% (61/81), and it was 71.8%(28/39) and 78.6%(33/42) in patients with primary induction failure and those experienced relapses respectively. For relapsed cases, it was 66.7%(12/18) and 87.5% (21/24) in cases experienced early or late relapses respectively.2. For the whole cohort, the 1-year and 2-year DFS rate were 48.4% and 34.5% respectively. For OS rate as well as DFS rate, no difference was observed between patients experienced primary induction failure or relapse. For patients attained CR after MAC regimen, the OS rate and DFS rate were 69.7% and 64.2% at 1 year respectively, and they were 45.9% and 41.3% at 2 years respectively. For patients attained CR (n=61) or not (n=20),1-year and 2-year OS rate were 80.5% vs 25.7% (p<0.0001) and 51.1% vs 0 (p<0.0001) respectively. Only 1 case of early death was observed.3. The median survival were 12 and 5 months in patients with white blood cell counts <100×109/L and≥100×l09/L respectively(p=0.0001).4. It was 7.5 and 4 months in FLT3 positive and negative patiens respectively (p=0.0001).5. No difference in OS or DFS rate was found for patients in different cytogenetic risk groups. ConclusionMAC was an effective and safe regimen for re-induction in patients experienced primary induction failure or relapse. It can provide opportunity for stem cell transplantation or further therapy, and significantly improve the prognosis.