Efficacy and Safety of High Dose Cyclophosphamide and Etoposide Induction in Patients with Relapsed/Refractory Acute Leukemia Ferrari AM, Moorman MT, Zapolskaya T, Rizzeri DA,and Mackey MC Duke University Hospital - PGY1 - Durham, NC
Background/Purpose: Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) are characterized by clonal proliferation of abnormally differentiated hematopoietic cells that infiltrate bone marrow, blood, and other tissues. Genetic mutations underlie the pathology of these diseases and despite recent advances in targeted therapeutics, initial treatment with traditional chemotherapeutic agents remains the standard of care. Remission and survival are limited by complications, refractory initial response, and relapsed disease. Due to concerns for cellular resistance, research evaluating alternative induction regimens excluding traditional chemotherapeutics, such as cytarabine, has been ongoing. In 2003, Talbot et al. published a case series summarizing the effects of treating seven relapsed/refractory AML patients with high dose cyclophosphamide with etoposide. Two patients achieved complete remission and three patients progressed to hematopoietic stem cell transplant (HSCT). Results demonstrated that concurrent administration of these agents could be efficacious and safely administered in relapsed/refractory acute leukemia. Since 2003, this combination regimen has been used at Duke University Hospital (DUH) in patients with relapsed/refractory hematologic malignancies.
Methodology: This single-center, retrospective analysis will evaluate the efficacy and safety of this high dose cyclophosphamide and etoposide induction regimen. Patients with relapsed/refractory AML and ALL who received combination treatment between June 1, 2003 and July 31, 2018 at DUH will be included. Pediatric patients and those previously exposed to the combination regimen will be excluded. The primary objective is to determine the complete remission rate of those who received this combination regimen. Secondary objectives include determining rates of 30-day mortality, partial response, and progression to HSCT. Safety profiles of those treated will also be characterized.
Presentation Objective: Describe the benefits and risks associated with high dose cyclophosphamide and etoposide in relapsed/refractory acute leukemia.
Self-Assessment: What is a primary limitation of using high dose cyclophosphamide and etoposide in a relapsed/refractory patient population?
