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Blood, 15 August 2005, Vol. 106, No. 4, pp. 1183-1188.
Prepublished online as a Blood First Edition Paper on May 10, 2005; DOI 10.1182/blood-2004-10-3821.
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Submitted October 4, 2004
Accepted April 24, 2005
Safety and efficacy of gemtuzumab ozogamicin (Mylotarg®) in pediatric patients with advanced CD33-positive acute myeloid leukemia
Robert J Arceci*, Jane Sande, Beverly Lange, Kevin Shannon, Janet Franklin, Raymond Hutchinson, Terry A Vik, David Flowers, Richard Aplenc, Mark S Berger, Matthew L Sherman, Franklin O Smith, Irwin Bernstein, and Eric L Sievers
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Children's Hospital of Philadelphia, Philadelphia, PA, USA
University of California at San Francisco, San Francisco, CA, USA
Children's Hospital of Los Angeles, Los Angeles, CA, USA
C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Wyeth Pharmaceuticals, Philadelphia, PA, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA
* Corresponding author; email: arcecro{at}jhmi.edu.
This open-label dose-escalation study evaluated the safety and efficacy of single-agent gemtuzumab ozogamicin (Mylotarg®), a humanized anti-CD33 antibody-targeted chemotherapeutic agent, for pediatric patients with multiple relapsed or primary refractory acute myeloid leukemia (AML). Twenty-nine children 1 to 16 years (relapse=19/refractory=10) received gemtuzumab ozogamicin ranging from 6 to 9 mg/m2 per dose for 2 doses (separated by 2 weeks) infused over 2 hours. All patients had anticipated myelosuppression. Other toxicities included grade 3/4 hyperbilirubinemia (7%) and elevated hepatic transaminases (21%); the incidence of grade 3/4 mucositis (3%) or sepsis (24%) was relatively low. One patient treated at 9 mg/m2 developed veno-occlusive disease (VOD) of the liver and defined the dose-limiting toxicity. Thirteen patients received hematopoietic stem cell transplantation < 3.5 months after the last dose of gemtuzumab ozogamicin; 6 (40%) developed VOD. Eight of 29 patients achieved overall remission (28%). Remissions were comparable in refractory (30%) and relapsed (26%) patients. Mean multidrug resistance protein-mediated drug efflux was significantly lower in the leukemic blasts of patients achieving remission (P< 0.005). Gemtuzumab ozogamicin was relatively well tolerated at 6 mg/m2 for 2 doses and was equally effective in refractory and relapsed patients. Further studies in combination with standard induction therapy for childhood AML are warranted.

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