Necrotizing Hemorrhagic Gastritis following Acute Myeloid Leukemia Induction with Midostaurin: An Unexpected Complication

2019 ◽  
Vol 143 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Shai Shimony ◽  
Hilla Reiss Mintz ◽  
Yulia Shvartser Beryozkin ◽  
Avivit Shoham ◽  
Pia Raanani ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Blood Count ◽  
Chemotherapy Regimen ◽  
Rare Complication ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Multikinase Inhibitor ◽  
Acute Myeloid ◽  
Count Recovery

Midostaurin is a tyrosine multikinase inhibitor approved for the treatment of patients with newly diagnosed acute myeloid leukemia (AML) with mutated Fms-like tyrosine kinase-3. We describe a case report of a 49-year-old AML patient treated with an intensive chemotherapy regimen followed by midostaurin. After achieving complete remission with blood count recovery, he suffered from a serious, rare complication of necrotizing hemorrhagic gastritis with no evidence of infection or malignant infiltration, possibly associated with midostaurin therapy.

scholarly journals Venetoclax Combined With Low-Dose Cytarabine for Previously Untreated Patients With Acute Myeloid Leukemia: Results From a Phase Ib/II Study

2019 ◽  
Vol 37 (15) ◽  
pp. 1277-1284 ◽  
Author(s):  
Andrew H. Wei ◽  
Stephen A. Strickland ◽  
Jing-Zhou Hou ◽  
Walter Fiedler ◽  
Tara L. Lin ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Blood Count ◽  
Low Dose ◽  
Intensive Chemotherapy ◽  
Phase Ib ◽  
Low Dose Cytarabine ◽  
Acute Myeloid ◽  
Count Recovery

PURPOSE Effective treatment options are limited for patients with acute myeloid leukemia (AML) who cannot tolerate intensive chemotherapy. An international phase Ib/II study evaluated the safety and preliminary efficacy of venetoclax, a selective B-cell leukemia/lymphoma-2 inhibitor, together with low-dose cytarabine (LDAC) in older adults with AML. PATIENTS AND METHODS Adults 60 years or older with previously untreated AML ineligible for intensive chemotherapy were enrolled. Prior treatment of myelodysplastic syndrome, including hypomethylating agents (HMA), was permitted. Eighty-two patients were treated at the recommended phase II dose: venetoclax 600 mg per day orally in 28-day cycles, with LDAC (20 mg/m2 per day) administered subcutaneously on days 1 to 10. Key end points were tolerability, safety, response rates, duration of response (DOR), and overall survival (OS). RESULTS Median age was 74 years (range, 63 to 90 years), 49% had secondary AML, 29% had prior HMA treatment, and 32% had poor-risk cytogenetic features. Common grade 3 or greater adverse events were febrile neutropenia (42%), thrombocytopenia (38%), and WBC count decreased (34%). Early (30-day) mortality was 6%. Fifty-four percent achieved complete remission (CR)/CR with incomplete blood count recovery (median time to first response, 1.4 months). The median OS was 10.1 months (95% CI, 5.7 to 14.2), and median DOR was 8.1 months (95% CI, 5.3 to 14.9 months). Among patients without prior HMA exposure, CR/CR with incomplete blood count recovery was achieved in 62%, median DOR was 14.8 months (95% CI, 5.5 months to not reached), and median OS was 13.5 months (95% CI, 7.0 to 18.4 months). CONCLUSION Venetoclax plus LDAC has a manageable safety profile, producing rapid and durable remissions in older adults with AML ineligible for intensive chemotherapy. High remission rate and low early mortality combined with rapid and durable remission make venetoclax and LDAC an attractive and novel treatment for older adults not suitable for intensive chemotherapy.

scholarly journals Impact of blood count recovery on outcomes of acute myeloid leukemia patients achieving morphologic leukemia-free state

2018 ◽  
Vol 8 (6) ◽  
Author(s):  
Wen-Yan Cheng ◽  
Yong-Mei Zhu ◽  
Zhao Liu ◽  
Xiang-Qin Weng ◽  
Jing-Ni Sui ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Blood Count ◽  
Free State ◽  
Acute Myeloid ◽  
Count Recovery

scholarly journals A Real World Study of Venetoclax Combined with Azacitidine in 64 Chinese Patients Newly Diagnosed Acute Myeloid Leukemia

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4414-4414
Author(s):  
Jiejing Qian ◽  
Jieyu Xu ◽  
Qing Hong ◽  
Yinjun Lou ◽  
Liping Mao ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Adverse Events ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Chinese Patients ◽  
Combination Regimen ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Acute Myeloid

Abstract Background: Venetoclax combined with azacitidine has been demonstrated to have a favorable overall response rate and tolerable safety in acute myeloid leukemia (AML) patients who are unfit for intensive chemotherapy. Methods: This study retrospectively recruited 64 Adults (≥18 years) with newly diagnosed AML ineligible for intensive chemotherapy who had received at least one cycle of treatment with venetoclax plus azacitidine. The primary endpoint was overall survival (OS). Secondary endpoints were remission rates. Safety was evaluated based on the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Results: The median age of the enrolled patients was 69 years. The median OS for the cohort was 15.5 months, with 21.2 months for complete responders as opposed to 13.3 months for those who did not achieve a complete response. 39 (60.9%) patients achieved composite complete remission (complete remission (CR) + CR with incomplete count recovery (CRi)) and 7/64 (10.9%) achieved morphologic leukemia-free state (MLFS) with a median follow-up time of 14.7 months. The median CR+CRi duration was 10.9 months. It is noteworthy that 43/64 (67.2%) patients achieved the best response after one cycle with a median time of 1.2 months. Normal karyotype (P=0.015) was significantly associated with extended OS in multivariate analysis, while higher white blood cell count (P=0.032), lower platelet count (p=0.018) and antifungal drug combination (P=0.013) were predictors of shortened OS in univariate analysis. Common grade 3/4 Adverse Events (AEs) included infection (68%) and hematological AEs consisting of neutropenia (93%), anemia (90%), leukopenia (86%), thrombocytopenia (77%) and febrile neutropenia (52%). The median neutropenia duration was 16 days. Conclusions: The novel venetoclax-azacitidine combination regimen showed prolonged survival period, promising efficacy, sound and rapid response, and superior tolerance in Chinese patients newly diagnosed AML. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Is Need Chemotherapy Titration During Acute Myeloid Leukemia Treatment?

2021 ◽  
pp. 1-5
Author(s):  
Ali Amanati ◽  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Minimal Residual Disease ◽  
Myeloid Leukemia ◽  
Poor Prognosis ◽  
Residual Disease ◽  
Rare Complication ◽  
Intensive Chemotherapy ◽  
Leukemia Treatment ◽  
Minimal Residual ◽  
Acute Myeloid

Persistent marrow aplasia is a rare complication with poor prognosis after intensive chemotherapy for acute myeloid leukemia. We present a 14-year-old boy with acute myeloid leukemia (AML), was complicated by chemotherapy induced persistent aplasia and he was expired because of prolonged neutropenia and pulmonary Aspergilosis. In this review we explain causes of persistent post chemotherapy persistent aplasia and prevention of this phenomenon during treatment with consideration of minimal residual disease (MRD) and response to question about chemotherapy titration dose.

Decitabine Versus Intensive Chemotherapy for Elderly Patients With Newly Diagnosed Acute Myeloid Leukemia

2019 ◽  
Vol 19 (5) ◽  
pp. 290-299.e3
Author(s):  
Eun-Ji Choi ◽  
Je-Hwan Lee ◽  
Han-Seung Park ◽  
Jung-Hee Lee ◽  
Miee Seol ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Myeloid Leukemia ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Acute Myeloid
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