Version June 2024
| Regimen | Common side effects | Comments |
| Cytarabine plus daunorubicin | Common nonhematologic side effects seen in the majority of patients include stomatitis (mostly mild), alopecia, nausea and vomiting (10 percent severe), and diarrhea (mostly mild). Daunorubicin can be associated with an infusion reaction and cardiac arrhythmias; a flu-like syndrome and rash due to cytarabine may be seen during induction. | Re-induction with cytarabine plus daunorubicin will produce a complete remission in approximately 50 percent of patients with a first remission lasting longer than one year[1]. |
| High-dose cytarabine (HiDAC) | The most common nonhematologic toxicities are nausea and vomiting, abnormal liver chemistries, diarrhea, conjunctivitis, rash, and cerebellar dysfunction. Toxicity is high in most patients over the age of 60 years. | HiDAC may be effective in 35 to 40 percent of patients resistant to conventional dose cytarabine regimens[2]. |
| High-dose cytarabine plus mitoxantrone (HAM) | In addition to the side effects described for HiDAC above, nonhematologic toxicities include stomatitis, infections, and neutropenic fever. Infrequent transient, mild cardiac failure and tachyarrhythmias have also been reported. | If an anthracycline (eg, daunorubicin) was not used during initial induction, the combination of HiDAC plus the synthetic anthracycline analogue, mitoxantrone, may produce higher response rates than HiDAC alone[3]. |
| High-dose cytarabine plus etoposide | In addition to the side effects described for HiDAC above, nonhematologic toxicities include hepatic toxicity, peripheral neuropathy, and anaphylactic-like reaction. | HiDAC plus etoposide results in similar response rates as HiDAC alone with a nonsignificant trend towards longer remission duration[4]. |
| Mitoxantrone plus etoposide | Nonhematologic toxicities include stomatitis, nausea, infections, and neutropenic fever. Infrequent transient, mild cardiac failure and tachyarrhythmias have also been reported. | Mitoxantrone and etoposide given together for five days is a commonly used regimen to treat refractory or relapsed AML and has demonstrated complete response rates of approximately 40 percent[5]. |
| Mitoxantrone, etoposide, cytarabine (MEC) | Side effects are similar to those described for mitoxantrone plus etoposide above, but also include hepatic dysfunction. | MEC demonstrates a trend towards higher complete response rates for patients <60 years old and those with unfavorable risk cytogenetics when compared with mitoxantrone plus etoposide alone[6]. |
| Gemtuzumab ozogamicin (GO) as a single agent or plus cytarabine and mitoxantrone | Serious adverse reactions to GO include fatal anaphylaxis, hemorrhage, teratogenicity, and hepatic injury including sinusoidal obstruction syndrome (also known as hepatic veno-occlusive disease), plus side effects similar to mitoxantrone plus cytarabine, above. | GO as a single agent or in combination with mitoxantrone plus cytarabine can achieve complete remission in up to 25 to 35 percent[7]. |
| Fludarabine, cytarabine, plus G-CSF (FLAG) | Studies including older adults have reported mild nonhematologic toxicity, most commonly with mucositis. | FLAG has reported complete remission rates of 45 to 55 percent in patients with primary refractory or relapsing AML[8]. |
| Cladribine, cytarabine, G-CSF (CLAG) | Nonhematologic toxicity is generally mild to moderate (grade I/II) and includes fever/infection, mucositis, nausea and vomiting, diarrhea, and alopecia. | CLAG results in a complete remission in approximately 50 percent of patients, with a median duration of response of 16 weeks[9]. |
| Cyclophosphamide plus high-dose etoposide | The most common non-hematologic toxicities include fever/infection, mucositis, hepatic toxicity, and hemorrhagic cystitis. | Approximately 42 percent of patients with resistant AML will achieve a complete remission[10]. |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
