Use of AMSA Combination Chemotherapy in Patients with Acute Myelogenous Leukemia Unsuitable for Anthracycline or Mitoxantrone Treatment

Abstract

Cardiotoxic drugs such as anthracyclines or mitoxantrone are essential components of most established chemotherapy regimens for the treatment of acute myelogenous leukemia (AML). In large multicenter trials, up to 20% of patients 60 years of age must be primarily excluded from treatment mostly due to their history or clinical signs of congestive heart failure or significant arrhythmias. In addition, many patients with relapsed or refractory disease have been heavily pretreated with anthracyclines and thus are not suitable for further administration of these substances. Studies on this poor-risk subgroup of AML patients are rare and focus on the use of low-dose cytosine arabinoside or other less aggressive drug regimens. Amsacrine has been reported as an effective antileukemic drug from numerous clinical trials since 1980. When administered in a total dose of about 600 mg/m2 in combination with conventional or high-dose cytosine arabinoside, response rates of up to 70% have been observed [1–10]. We therefore conducted a clinical study on the use of amsacrine in combination with cytosine arabinoside for first-line or reinduction chemotherapy in AML patients unsuitable for anthracycline or mitoxantrone treatment.