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Rebecca Olin, MD, MS

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Outpatient Chemotherapy Regimen Under Study in Pediatric AML

By: Kelly M. Hennessey, PhD
Posted: Monday, November 30, 2020

The combination chemotherapy regimen of cytarabine, daunorubicin, and etoposide (ADE) was shown to be an effective induction regimen in pediatric patients with relapsed acute myeloid leukemia (AML), according to Sameer Bakhshi, PhD, of All India Institute of Medical Sciences, New Delhi, and colleagues. The researchers evaluated the efficacy, along with safety and toxicity, of the combination treatment in this patient setting. The goal of treatment at relapse is to use induction chemotherapy to achieve a second complete response and proceed to allogeneic hematopoietic stem cell transplantation (HSCT). The results of their study were published in Pediatric Blood & Cancer.

This prospective single-arm phase II study was carried out from January 2017 to December 2018. A total of 45 patients were included in the study. All patients received 100 mg/m2 of cytarabine twice daily, on days 1 to 10, 50 mg/m2 of daunorubicin on days 1 to 3, and 100 mg/m2 of etoposide on days 1 to 5, in addition to intrathecal triple therapy as prophylaxis, adjusted for age. Upon completion of induction therapy, 29 patients achieved complete remission, 24 of whom tested negative for minimal residual disease. The presence of fever at the time of relapse appeared to be a predictor of reduced complete remission, minimal residual disease positivity, and lower event-free survival. 

Of the patients who achieved complete remission, 15 received stem cell transplantation; palliative care was recommended to patients who were not in complete remission. The estimated 2-year event-free survival was 29% (n = 13), and the overall survival rate was 34% (n = 15). At the time of the last follow-up, 29% of patients retained remission status.

The use of ADE for patients with relapsed AML is “an effective induction regimen with reasonable toxicity profile, and it is feasible to administer it in an outpatient basis if supportive care is optimized,” concluded the researchers.

Disclosure: The study authors reported no conflicts of interest.


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