Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid

Chiara Pilatrino, Daniela Cilloni, Emanuela Messa, Alessandro Morotti, Emilia Giugliano, Marisa Pautasso, Ubaldo Familiari, Susanna Cappia, Pier Giuseppe Pelicci, Francesco Lo Coco, Giuseppe Saglio, Angelo Guerrasio

Research output: Contribution to journalArticle

Abstract

BACKGROUND. The authors investigated the efficacy and safety of the histone deacetylase inhibitors valproic acid (VPA) and all-trans retinoic acid (ATRA) as differentiation agents in a cohort of older, poor-risk patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). METHODS. Twenty older patients with recurrent or refractory AML or MDS were treated in a Phase II protocol with sequential VPA and ATRA therapy. VPA was started at a dose of 10 mg/kg per day and then escalated to achieve the serum concentration of 45-100 μg/mL. ATRA was added at 45 mg/square meters (sm) per day when VPA reached the target serum concentration. Only patients treated continuously for ≥ 2 months were considered evaluable. RESULTS. Hematologic improvement, according to World Health Organization criteria, was observed in 6 of 20 patients enrolled in the protocol but in 6 of 11 considered evaluable. In five patients, a major platelet response was observed, achieving platelet transfusion independence. Three of these five patients also exhibited a minor erythroid response. A sixth patient showed both a minor erythroid response and a platelet response. The median duration of response was 189 days (range, 63-550 days). No significant reduction in the blast count was observed. Grade 3 neurocortical toxicity was observed in four patients. Severe bone pain was experienced by 4 patients (2 Grade 4 and 2 Grade 3) and was associated with an increase in the peripheral blast cell count. Treatment with ATRA did not modify the response observed with VPA alone. CONCLUSIONS: Differentiation therapy with VPA was of clinical benefit in approximately 30% of elderly patients with AML and MDS of the refractory anemia with excess of blast type with unfavorable prognostic features. A striking platelet transfusion independence lasting several months may be obtained in some patients, reducing the burden of palliative care and improving the quality of life.

Original languageEnglish
Pages (from-to)101-109
Number of pages9
JournalCancer
Volume104
Issue number1
DOIs
Publication statusPublished - Jul 1 2005

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Myelodysplastic Syndromes
Valproic Acid
Tretinoin
Platelet Count
Acute Myeloid Leukemia
Platelet Transfusion
Blood Platelets
Refractory Anemia with Excess of Blasts
Histone Deacetylase Inhibitors
Serum
Palliative Care
Therapeutics
Cell Count
Quality of Life
Safety
Bone and Bones
Pain

Keywords

  • Acute myeloid leukemia
  • Differentiation therapy
  • Histone deacetylase inhibitors
  • Myelodysplasia
  • Poor-risk patients
  • Valproic acid

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid. / Pilatrino, Chiara; Cilloni, Daniela; Messa, Emanuela; Morotti, Alessandro; Giugliano, Emilia; Pautasso, Marisa; Familiari, Ubaldo; Cappia, Susanna; Pelicci, Pier Giuseppe; Lo Coco, Francesco; Saglio, Giuseppe; Guerrasio, Angelo.

In: Cancer, Vol. 104, No. 1, 01.07.2005, p. 101-109.

Research output: Contribution to journalArticle

Pilatrino, C, Cilloni, D, Messa, E, Morotti, A, Giugliano, E, Pautasso, M, Familiari, U, Cappia, S, Pelicci, PG, Lo Coco, F, Saglio, G & Guerrasio, A 2005, 'Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid', Cancer, vol. 104, no. 1, pp. 101-109. https://doi.org/10.1002/cncr.21132
Pilatrino, Chiara ; Cilloni, Daniela ; Messa, Emanuela ; Morotti, Alessandro ; Giugliano, Emilia ; Pautasso, Marisa ; Familiari, Ubaldo ; Cappia, Susanna ; Pelicci, Pier Giuseppe ; Lo Coco, Francesco ; Saglio, Giuseppe ; Guerrasio, Angelo. / Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid. In: Cancer. 2005 ; Vol. 104, No. 1. pp. 101-109.
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abstract = "BACKGROUND. The authors investigated the efficacy and safety of the histone deacetylase inhibitors valproic acid (VPA) and all-trans retinoic acid (ATRA) as differentiation agents in a cohort of older, poor-risk patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). METHODS. Twenty older patients with recurrent or refractory AML or MDS were treated in a Phase II protocol with sequential VPA and ATRA therapy. VPA was started at a dose of 10 mg/kg per day and then escalated to achieve the serum concentration of 45-100 μg/mL. ATRA was added at 45 mg/square meters (sm) per day when VPA reached the target serum concentration. Only patients treated continuously for ≥ 2 months were considered evaluable. RESULTS. Hematologic improvement, according to World Health Organization criteria, was observed in 6 of 20 patients enrolled in the protocol but in 6 of 11 considered evaluable. In five patients, a major platelet response was observed, achieving platelet transfusion independence. Three of these five patients also exhibited a minor erythroid response. A sixth patient showed both a minor erythroid response and a platelet response. The median duration of response was 189 days (range, 63-550 days). No significant reduction in the blast count was observed. Grade 3 neurocortical toxicity was observed in four patients. Severe bone pain was experienced by 4 patients (2 Grade 4 and 2 Grade 3) and was associated with an increase in the peripheral blast cell count. Treatment with ATRA did not modify the response observed with VPA alone. CONCLUSIONS: Differentiation therapy with VPA was of clinical benefit in approximately 30{\%} of elderly patients with AML and MDS of the refractory anemia with excess of blast type with unfavorable prognostic features. A striking platelet transfusion independence lasting several months may be obtained in some patients, reducing the burden of palliative care and improving the quality of life.",
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T1 - Increase in platelet count in older, poor-risk patients with acute myeloid leukemia or myelodysplastic syndrome treated with valproic acid and all-trans retinoic acid

AU - Pilatrino, Chiara

AU - Cilloni, Daniela

AU - Messa, Emanuela

AU - Morotti, Alessandro

AU - Giugliano, Emilia

AU - Pautasso, Marisa

AU - Familiari, Ubaldo

AU - Cappia, Susanna

AU - Pelicci, Pier Giuseppe

AU - Lo Coco, Francesco

AU - Saglio, Giuseppe

AU - Guerrasio, Angelo

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N2 - BACKGROUND. The authors investigated the efficacy and safety of the histone deacetylase inhibitors valproic acid (VPA) and all-trans retinoic acid (ATRA) as differentiation agents in a cohort of older, poor-risk patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). METHODS. Twenty older patients with recurrent or refractory AML or MDS were treated in a Phase II protocol with sequential VPA and ATRA therapy. VPA was started at a dose of 10 mg/kg per day and then escalated to achieve the serum concentration of 45-100 μg/mL. ATRA was added at 45 mg/square meters (sm) per day when VPA reached the target serum concentration. Only patients treated continuously for ≥ 2 months were considered evaluable. RESULTS. Hematologic improvement, according to World Health Organization criteria, was observed in 6 of 20 patients enrolled in the protocol but in 6 of 11 considered evaluable. In five patients, a major platelet response was observed, achieving platelet transfusion independence. Three of these five patients also exhibited a minor erythroid response. A sixth patient showed both a minor erythroid response and a platelet response. The median duration of response was 189 days (range, 63-550 days). No significant reduction in the blast count was observed. Grade 3 neurocortical toxicity was observed in four patients. Severe bone pain was experienced by 4 patients (2 Grade 4 and 2 Grade 3) and was associated with an increase in the peripheral blast cell count. Treatment with ATRA did not modify the response observed with VPA alone. CONCLUSIONS: Differentiation therapy with VPA was of clinical benefit in approximately 30% of elderly patients with AML and MDS of the refractory anemia with excess of blast type with unfavorable prognostic features. A striking platelet transfusion independence lasting several months may be obtained in some patients, reducing the burden of palliative care and improving the quality of life.

AB - BACKGROUND. The authors investigated the efficacy and safety of the histone deacetylase inhibitors valproic acid (VPA) and all-trans retinoic acid (ATRA) as differentiation agents in a cohort of older, poor-risk patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). METHODS. Twenty older patients with recurrent or refractory AML or MDS were treated in a Phase II protocol with sequential VPA and ATRA therapy. VPA was started at a dose of 10 mg/kg per day and then escalated to achieve the serum concentration of 45-100 μg/mL. ATRA was added at 45 mg/square meters (sm) per day when VPA reached the target serum concentration. Only patients treated continuously for ≥ 2 months were considered evaluable. RESULTS. Hematologic improvement, according to World Health Organization criteria, was observed in 6 of 20 patients enrolled in the protocol but in 6 of 11 considered evaluable. In five patients, a major platelet response was observed, achieving platelet transfusion independence. Three of these five patients also exhibited a minor erythroid response. A sixth patient showed both a minor erythroid response and a platelet response. The median duration of response was 189 days (range, 63-550 days). No significant reduction in the blast count was observed. Grade 3 neurocortical toxicity was observed in four patients. Severe bone pain was experienced by 4 patients (2 Grade 4 and 2 Grade 3) and was associated with an increase in the peripheral blast cell count. Treatment with ATRA did not modify the response observed with VPA alone. CONCLUSIONS: Differentiation therapy with VPA was of clinical benefit in approximately 30% of elderly patients with AML and MDS of the refractory anemia with excess of blast type with unfavorable prognostic features. A striking platelet transfusion independence lasting several months may be obtained in some patients, reducing the burden of palliative care and improving the quality of life.

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KW - Myelodysplasia

KW - Poor-risk patients

KW - Valproic acid

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