Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia

Miloslav Beran, Elihu Estey, Susan O'Brien, Jorge Cortes, Charles A. Koller, Francis J. Giles, Steven Kornblau, Michael Andreeff, Norbert Vey, Sherry R. Pierce, Kimberly Hayes, Gee Chuan Wong, Michael Keating, Hagop Kantarjian

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the efficacy and safety of the combination of topotecan and cytarabine in patients with myelodysplastic syndromes (MDSs) and chronic myelomonocytic leukemia (CMML). Patients and Methods: Fifty-nine patients with MDSs and 27 with CMML were enrolled. They were either previously untreated (66%) or had received only biologic agents (14%) or chemotherapy with or without biologic agents (20%). Treatment consisted of topotecan 1.25 mg/m2 by continuous intravenous infusion daily for 5 days and cytarabine 1.0 g/m2 by infusion over 2 hours daily for 5 days. Prophylaxis included antibacterial, antifungal, and antiviral agents. At a median follow- up of 7 months, all 86 patients were assessable for response and toxicity. Results: Complete remission (CR) was observed in 48 patients (56%; 61% with MDSs, 44% with CMML; P = .15). Similar CR rates were observed for patients with good-risk and poor-risk MDS (70% and 56%, respectively). The treatment effectively induced CR in patients with a poor-prognosis karyotype involving chromosomes 5 and 7 (CR, 71%) and secondary MDSs (CR, 72%). Fifty-four patients received one induction course, 25 patients received two, and the rest received more than two. The median number of continuation courses was two. The median overall duration of CR was 34 weeks (50 weeks for MDSs and 33 weeks for CMML). The median survival was 60 weeks for MDS and 44 weeks for CMML patients. CR and survival durations were longer in patients with refractory anemia with excess blasts (RAEB). Grade 3 or 4 mucositis or diarrhea was observed in three patients each. Fever was observed in 63%, and infections in 49% of patients. Six patients (7%) died during induction therapy. Conclusion: Topotecan and cytarabine induced high CR rates in unselected patients with MDSs and CMML, particularly among patients with poor-prognosis cytogenetics and secondary MDSs. Topotecan-cytarabine is an active induction regimen in MDS and CMML patients, is well tolerated, and is associated with a low mortality rate.

Original languageEnglish (US)
Pages (from-to)2819-2830
Number of pages12
JournalJournal of Clinical Oncology
Volume17
Issue number9
StatePublished - Sep 1 1999
Externally publishedYes

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Leukemia, Myelomonocytic, Chronic
Topotecan
Myelodysplastic Syndromes
Cytarabine
Biological Factors
Refractory Anemia with Excess of Blasts
Chromosomes, Human, Pair 5
Mucositis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Beran, M., Estey, E., O'Brien, S., Cortes, J., Koller, C. A., Giles, F. J., ... Kantarjian, H. (1999). Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia. Journal of Clinical Oncology, 17(9), 2819-2830.

Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia. / Beran, Miloslav; Estey, Elihu; O'Brien, Susan; Cortes, Jorge; Koller, Charles A.; Giles, Francis J.; Kornblau, Steven; Andreeff, Michael; Vey, Norbert; Pierce, Sherry R.; Hayes, Kimberly; Wong, Gee Chuan; Keating, Michael; Kantarjian, Hagop.

In: Journal of Clinical Oncology, Vol. 17, No. 9, 01.09.1999, p. 2819-2830.

Research output: Contribution to journalArticle

Beran, M, Estey, E, O'Brien, S, Cortes, J, Koller, CA, Giles, FJ, Kornblau, S, Andreeff, M, Vey, N, Pierce, SR, Hayes, K, Wong, GC, Keating, M & Kantarjian, H 1999, 'Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia', Journal of Clinical Oncology, vol. 17, no. 9, pp. 2819-2830.
Beran, Miloslav ; Estey, Elihu ; O'Brien, Susan ; Cortes, Jorge ; Koller, Charles A. ; Giles, Francis J. ; Kornblau, Steven ; Andreeff, Michael ; Vey, Norbert ; Pierce, Sherry R. ; Hayes, Kimberly ; Wong, Gee Chuan ; Keating, Michael ; Kantarjian, Hagop. / Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 9. pp. 2819-2830.
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abstract = "Purpose: To evaluate the efficacy and safety of the combination of topotecan and cytarabine in patients with myelodysplastic syndromes (MDSs) and chronic myelomonocytic leukemia (CMML). Patients and Methods: Fifty-nine patients with MDSs and 27 with CMML were enrolled. They were either previously untreated (66{\%}) or had received only biologic agents (14{\%}) or chemotherapy with or without biologic agents (20{\%}). Treatment consisted of topotecan 1.25 mg/m2 by continuous intravenous infusion daily for 5 days and cytarabine 1.0 g/m2 by infusion over 2 hours daily for 5 days. Prophylaxis included antibacterial, antifungal, and antiviral agents. At a median follow- up of 7 months, all 86 patients were assessable for response and toxicity. Results: Complete remission (CR) was observed in 48 patients (56{\%}; 61{\%} with MDSs, 44{\%} with CMML; P = .15). Similar CR rates were observed for patients with good-risk and poor-risk MDS (70{\%} and 56{\%}, respectively). The treatment effectively induced CR in patients with a poor-prognosis karyotype involving chromosomes 5 and 7 (CR, 71{\%}) and secondary MDSs (CR, 72{\%}). Fifty-four patients received one induction course, 25 patients received two, and the rest received more than two. The median number of continuation courses was two. The median overall duration of CR was 34 weeks (50 weeks for MDSs and 33 weeks for CMML). The median survival was 60 weeks for MDS and 44 weeks for CMML patients. CR and survival durations were longer in patients with refractory anemia with excess blasts (RAEB). Grade 3 or 4 mucositis or diarrhea was observed in three patients each. Fever was observed in 63{\%}, and infections in 49{\%} of patients. Six patients (7{\%}) died during induction therapy. Conclusion: Topotecan and cytarabine induced high CR rates in unselected patients with MDSs and CMML, particularly among patients with poor-prognosis cytogenetics and secondary MDSs. Topotecan-cytarabine is an active induction regimen in MDS and CMML patients, is well tolerated, and is associated with a low mortality rate.",
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T1 - Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia

AU - Beran, Miloslav

AU - Estey, Elihu

AU - O'Brien, Susan

AU - Cortes, Jorge

AU - Koller, Charles A.

AU - Giles, Francis J.

AU - Kornblau, Steven

AU - Andreeff, Michael

AU - Vey, Norbert

AU - Pierce, Sherry R.

AU - Hayes, Kimberly

AU - Wong, Gee Chuan

AU - Keating, Michael

AU - Kantarjian, Hagop

PY - 1999/9/1

Y1 - 1999/9/1

N2 - Purpose: To evaluate the efficacy and safety of the combination of topotecan and cytarabine in patients with myelodysplastic syndromes (MDSs) and chronic myelomonocytic leukemia (CMML). Patients and Methods: Fifty-nine patients with MDSs and 27 with CMML were enrolled. They were either previously untreated (66%) or had received only biologic agents (14%) or chemotherapy with or without biologic agents (20%). Treatment consisted of topotecan 1.25 mg/m2 by continuous intravenous infusion daily for 5 days and cytarabine 1.0 g/m2 by infusion over 2 hours daily for 5 days. Prophylaxis included antibacterial, antifungal, and antiviral agents. At a median follow- up of 7 months, all 86 patients were assessable for response and toxicity. Results: Complete remission (CR) was observed in 48 patients (56%; 61% with MDSs, 44% with CMML; P = .15). Similar CR rates were observed for patients with good-risk and poor-risk MDS (70% and 56%, respectively). The treatment effectively induced CR in patients with a poor-prognosis karyotype involving chromosomes 5 and 7 (CR, 71%) and secondary MDSs (CR, 72%). Fifty-four patients received one induction course, 25 patients received two, and the rest received more than two. The median number of continuation courses was two. The median overall duration of CR was 34 weeks (50 weeks for MDSs and 33 weeks for CMML). The median survival was 60 weeks for MDS and 44 weeks for CMML patients. CR and survival durations were longer in patients with refractory anemia with excess blasts (RAEB). Grade 3 or 4 mucositis or diarrhea was observed in three patients each. Fever was observed in 63%, and infections in 49% of patients. Six patients (7%) died during induction therapy. Conclusion: Topotecan and cytarabine induced high CR rates in unselected patients with MDSs and CMML, particularly among patients with poor-prognosis cytogenetics and secondary MDSs. Topotecan-cytarabine is an active induction regimen in MDS and CMML patients, is well tolerated, and is associated with a low mortality rate.

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