Cladribine, cytarabine, filgrastim, and mitoxantrone (CLAG-M) compared to standard induction in acute myeloid leukemia from myelodysplastic syndrome after azanucleoside failure

Michael V Jaglal; Vu H Duong; Celeste M Bello; Najla H Al Ali; Eric Padron; Hugo F Fernandez; Alan F List; Jeffrey E Lancet; Rami S Komrokji

doi:10.1016/j.leukres.2013.12.010

Cladribine, cytarabine, filgrastim, and mitoxantrone (CLAG-M) compared to standard induction in acute myeloid leukemia from myelodysplastic syndrome after azanucleoside failure

Leuk Res. 2014 Apr;38(4):443-6. doi: 10.1016/j.leukres.2013.12.010. Epub 2013 Dec 25.

Authors

Michael V Jaglal¹, Vu H Duong², Celeste M Bello¹, Najla H Al Ali¹, Eric Padron¹, Hugo F Fernandez¹, Alan F List¹, Jeffrey E Lancet¹, Rami S Komrokji³

Affiliations

¹ H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
² University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA.
³ H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: rami.komrokji@moffitt.org.

PMID: 24439565
DOI: 10.1016/j.leukres.2013.12.010

Abstract

For patients with acute myeloid leukemia from antecedent myelodysplastic syndrome particularly after azanucleoside treatment failure, outcome is poor. Here, we conducted a case-control study in these patients to compare the efficacy of CLAG-M induction (28 patients) versus standard 3+7 induction chemotherapy (24 patients). Response rates (P=0.014) and median overall survival (P=0.025) were 64% and 202 days (95% CI 37-367 days) versus 29% and 86 days (95% CI 36-136) in the CLAG-M and 3+7 cohorts, respectively. Median overall survival was 202 (95% CI 37-367 days) versus 86 days (95% CI 36-136) (P=0.025), respectively. CLAG-M has encouraging activity in this patient group.

Keywords: Antecedent hematological disorders; Azanucleoside treatment failure; Cladrabine; Secondary AML.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols*
Azacitidine / therapeutic use*
Case-Control Studies
Chemotherapy, Adjuvant / adverse effects
Chemotherapy, Adjuvant / standards
Cladribine
Cytarabine
Disease Progression
Drug Resistance, Neoplasm / drug effects
Female
Filgrastim
Granulocyte Colony-Stimulating Factor / administration & dosage*
Granulocyte Colony-Stimulating Factor / adverse effects
Humans
Induction Chemotherapy / adverse effects
Induction Chemotherapy / standards
Leukemia, Myeloid, Acute / drug therapy*
Leukemia, Myeloid, Acute / mortality
Leukemia, Myeloid, Acute / pathology
Male
Middle Aged
Mitoxantrone / administration & dosage*
Mitoxantrone / adverse effects
Myelodysplastic Syndromes / drug therapy*
Myelodysplastic Syndromes / pathology
Recombinant Proteins / administration & dosage
Recombinant Proteins / adverse effects
Treatment Failure
Young Adult

Substances

Recombinant Proteins
Cytarabine
Granulocyte Colony-Stimulating Factor
Cladribine
Mitoxantrone
Azacitidine
Filgrastim

Supplementary concepts

CLAG protocol