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Blood, 23 April 2009, Vol. 113, No. 17, pp. 3903-3910. Prepublished online as a Blood First Edition Paper on January 8, 2009; DOI 10.1182/blood-2008-07-162842. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2008-07-162842v1 113/17/3903    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Braess, J. Articles by Hiddemann, W. Search for Related Content PubMed PubMed Citation Articles by Braess, J. Articles by Hiddemann, W. Related Collections Free Research Articles Myeloid Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Dose-dense induction with sequential high-dose cytarabine and mitoxantone (S-HAM) and pegfilgrastim results in a high efficacy and a short duration of critical neutropenia in de novo acute myeloid leukemia: a pilot study of the AMLCG Jan Braess1, Karsten Spiekermann1, Peter Staib2,3, Andreas Grüneisen4, Bernhard Wörmann5, Wolf-Dieter Ludwig6, Hubert Serve7, Albrecht Reichle8, Rudolf Peceny9, Daniel Oruzio10, Christoph Schmid10, Xaver Schiel11, Marcus Hentrich11, Christina Sauerland12, Michael Unterhalt1, Michael Fiegl1, Wolfgang Kern13, Christian Buske1, Stefan Bohlander1, Achim Heinecke12, Herrad Baurmann14, Dietrich W. Beelen15, Wolfgang E. Berdel16, Thomas Büchner16, and Wolfgang Hiddemann1 1 Klinikum Grosshadern der LMU, München; 2 Universitätsklinikum, Köln; 3 St-Antonius-Hospital, Eschweiler; 4 Vivantes Klinikum Berlin-Neukölln, Berlin; 5 Städtisches Klinikum, Braunschweig; 6 Robert-Rössle-Klinik, Campus Berlin-Buch, Berlin; 7 Klinikum der J. W. Goethe-Universität, Frankfurt; 8 Klinikum der Universität, Regensburg; 9 Klinikum Osnabrück, Osnabrück; 10 Zentralklinikum, Augsburg; 11 Städtisches Klinikum München, Klinikum Harlaching, München; 12 Institut für Medizinische Informatik und Biomathematik, Universität, Münster; 13 MLL Münchner Leukämielabor, München; 14 Deutsche Klinik für Diagnostik, Wiesbaden; 15 Universitätsklinikum, Essen; and 16 Universitätsklinikum Münster, Münster, Germany Dose density during early induction has been demonstrated to be one of the prime determinants for treatment efficacy in acute myeloid leukemia (AML). The German AML Cooperative Group has therefore piloted a dose-dense induction regimen sequential high-dose AraC and mitoxantrone followed by pegfilgrastim (S-HAM) in which 2 induction cycles are applied over 11 to 12 days instead of 25 to 29 days as used in conventional double induction, thereby increasing dose density 2-fold. Of 172 de novo AML patients (excluding acute promyelocytic leukemia), 61% reached a complete remission, 22% a complete remission with incomplete peripheral recovery, 7% had persistent leukemia, 10% died (early death) resulting in an overall response rate of 83%. Kaplan-Meier estimated survival at 2 years was 61% for the whole group (patients with unfavorable karyotypes, 38%; patients with favorable karyotypes, 69%; patients with intermediate karyotypes, 75%) after S-HAM treatment. Importantly, the compression of the 2 induction cycles into the first 11 to 12 days of treatment was beneficial for normal hematopoiesis as demonstrated by a significantly shortened duration of critical neutropenia of 31 days compared with 46 days after conventionally timed double induction. (European Leukemia Trial Registry LN_AMLINT_2004_230.) CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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