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 >60yr, 8] were treated with HAEP [high-dose cytarabine (2g/m(2)), etoposide (100mg/m(2)) and cisplatin (20mg/m(2)) for five alternative days] as salvage therapy. Patients who had the first relapse at <6months 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 >= 60yr, 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 AML.