Qiuhu Shi

Long-term follow-up of high-dose mitoxantrone-based induction therapy for patients with newly-diagnosed acute myelogenous leukemia. Twelve year results from a single institution

This report provides long-term results of the treatment of patients with newly-diagnosed AML with a single high dose of mitoxantrone combined with once daily cytarabine. One-hundred and sixty-five patients treated on four studies of high-dose mitoxantrone-based induction therapy are included. Patients with a prior antecedent hematologic disorder were eligible. The median follow-up time is 65.9 months (95% CI: 55.7–86.2 months). The overall complete remission rate was 64%, with responses in 78% of patients less than 60 years of age and 51% of patients 60 years of age or older. The median duration of response is 21.2 months and 8.0 months and overall survival is 15.4 months and 7.6 months, respectively. For a sub-set of patients who would be eligible for most US trials, the complete remission rate was 84% in younger patients and 60% in older patients. The median duration of response was 39.0 and 8.2 months and the median overall survival was 19.4 and 7.6 months, respectively. The efficacy of these regimens compared favorably to results reported with standard ‘3 + 7’ regimens. Use of a once-daily cytarabine regimen resulted in almost no neurotoxicity and allowed for administration of consolidation in the outpatient setting.

High-Dose Cytarabine-Mitoxantrone Versus Hyper-CVAD in Adult Acute Lymphoblastic Leukemia and Burkitt’s Lymphoma: A Single Center Experience of Two Induction Regimens

The treatment of acute lymphoblastic leukemia (ALL) in children has made significant progress. However, the treatment for adult ALL patients has been less successful. The majority of adult patients develop recurrent disease and subsequently die of their leukemia. This study reports a single center experience of adult ALL therapy with two different induction regimens. 73 adult patients with newly diagnosed ALL were treated at the Westchester Medical Center. These patients received induction chemotherapy with either high dose mitoxantrone and high-dose cytarabine (HDAM, n=52) or Hyper-CVAD (n=21). The complete remission (CR) rate was 87% in the HDAM group and 76% in the Hyper-CVAD group (p=0.31). The median CR duration was 34 months (95% CI, 14 -) for the HDAM group, and 18 months (95% CI, 9 -) for the hyper-CVAD group, respectively. The median overall survival (OS) for patients in the HDAM group was 21 months (95% confidence interval [CI], 13 35 months). The 3-year and 5-year OS was 35% and 30%, respectively. In the Hyper-CVAD group, median OS was 27 months (95% CI, 12 -), with a 3-year OS of 44%. The difference of CR duration and OS between the two groups was not statistically significant (p= 0.86 for CR, p=0.73 for OS). The statistically significant favorable prognostic factors for overall survival include HDAM induction, karyotyping other than t(9;22) and t(4;11), day 1 platelet count 20,000 x 10 6 /L, age < 35, day 1 WBC <10 x 10 6 /L. In conclusion, the two regimens are comparable in this retrospective analysis for ALL induction from a single center. HDAM induction was found to be a favorable prognostic factor for overall survival.

Prospective evaluation of 2009 H1N1 influenza A in patients admitted with fever to an oncology unit.

We prospectively evaluated all oncology inpatients for 2009 H1N1 influenza virus. All patients recovered completely. Evaluating all oncology patients with fever for influenza involved overtreatment of influenza-negative patients and involved a significant infection control burden. However, early antiviral intervention could have contributed to a favorable outcome.

Sildenafil and Retinopathy of Prematurity in Preterm Infants with Bronchopulmonary Dysplasia

Objective To assess whether sildenafil is associated with worsening retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants (≤1500 g) with bronchopulmonary dysplasia (BPD). Study design This retrospective case‐control study included VLBW infants admitted to the neonatal intensive care unit between January 1, 2006, and December 31, 2012. Each infant treated with sildenafil was assigned 3 unexposed controls matched for gestational age, birth weight, and BPD diagnosis. Severe ROP was defined as stage ≥3 ROP. Worsening ROP was defined as increased stage of ROP within 8 weeks + 4 days after initiation of sildenafil or matched postmenstrual age. Results Twenty‐three exposed infants and 69 matched controls met the inclusion criteria for the study (mean birth weight, 715 ± 210 g; mean gestational age, 25 ± 1 weeks). The mean postmenstrual age at sildenafil treatment was 42 ± 8 weeks. Exposed infants had more days of respiratory support (mean, 208 ± 101 days vs 102 ± 33 days; P < .001). Exposed infants had a higher prevalence of severe ROP (26% [6 of 23] vs 7% [5 of 69]; OR, 6.4; 95% CI, 1.2‐32.9; P = .026). Five exposed infants and 2 unexposed infants had severe ROP before starting sildenafil and were excluded from the analysis for worsening ROP. The rate of worsening ROP did not differ significantly between exposed infants and unexposed infants ((41% [7 of 17] vs 24% [12 of 51]; OR, 8.4; 95% CI, 0.9‐78.6; P = .061). Conclusion Although sildenafil treatment was not statistically significantly associated with worsening of ROP, the raw difference in ROP rate is concerning. Larger studies are warranted to confirm this finding.