Effective salvage therapy for high-risk relapsed or refractory acute myeloid leukaemia with cisplatin in combination with high-dose cytarabine and etoposide

Objectives: This study aimed at evaluating the efficacy and toxicity of the combination regimen of high-dose cytarabine, etoposide and cisplatin (HAEP) in adult patients with high-risk relapsed or refractory acute myeloid leukaemia (AML). Methods: From January 2001 to December 2012, 49 relapsed or refractory AML patients [36 men; 13 women; median age, 42 (range, 18-71) yr; patients aged >60 yr, 8] were treated with HAEP [high-dose cytarabine (2 g/m²), etoposide (100 mg/m²) and cisplatin (20 mg/m²) for five alternative days] as salvage therapy. Patients who had the first relapse at <6 months after an initial complete remission (CR), had a second or subsequent relapse, were primary refractory to ≥2 courses of front-line conventional induction chemotherapy or were refractory to re-induction chemotherapy after any relapse was eligible for HAEP treatments. Results: The overall CR + CR without platelet recovery (CRp) rates among 49 evaluable patients were 31% [95% confidence interval (CI), 17-44%]. Of the eight patients aged ≥60 yr, none showed any response to HAEP treatment. The CR + CRp rate was 54% in patients with second or greater relapse and 25% in patients refractory to re-induction therapy after relapse. In multivariate analysis, younger age, favourable cytogenetics and no prior salvage chemotherapy were independent predictors for better responses. Conclusion: Our findings suggest that HAEP is an effective salvage chemotherapy for patients aged <60 yr with high-risk relapsed or refractory AML.