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Etoposide pharmacokinetics in children treated for acute myeloid leukemia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk forskning/Lönnerholm)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk forskning/Lönnerholm)
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2006 (English)In: Anti-Cancer Drugs, ISSN 0959-4973, E-ISSN 1473-5741, Vol. 17, no 9, 1087-1094 p.Article in journal (Refereed) Published
Abstract [en]

We studied the pharmacokinetics of etoposide in 45 children treated for newly diagnosed acute myeloid leukemia. Etopcoside, 100 mg/m(2) body surface area/24h, was administered by 96-h continuous intravenous infusion. Concomitantly, the children received cytarabine 200 mg/m(2)/24 h by intravenous infusion and 6-thioguanine 100 mg/m(2) twice daily orally. Median total body clearance in children 0.5-11.8 (n=4) and 2.3-17.7 years old (n=36) without Down's syndrome was 17.1 and 17.6 ml/min/m(2), respectively (P=0.96). Five children with Down's syndrome had a median clearance of 13.6 ml/min/m(2) (P=0.067 compared with non-Down's syndrome children). Eighteen of the children received a second identical treatment course 3-4 weeks later; there was a significant correlation between individual clearance values (p=0.56; P=0.017). We found no significant correlation between etoposide pharmacolkinetics and the remission rate or the relapse rate. In conclusion, our findings indicate that special dose-calculation guidelines for infants above 3 months old are not substantiated by age-dependent pharmacolkinetics of etoposide. Down's syndrome children might be candidates for dose reduction if our data are confirmed in larger numbers of patients. Low course-to-course variability indicates that pharmacolkinetically guided dosing of etoposide might be clinically relevant, if larger studies can demonstrate that this approach decreases toxicity or increases response rates.

Place, publisher, year, edition, pages
2006. Vol. 17, no 9, 1087-1094 p.
Keyword [en]
acute myelold leukemia, childhood, etoposide, pharmacokinetics, Mb Down
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-97403DOI: 10.1097/01.cad.0000231470.54288.49ISI: 000241603500012PubMedID: 17001183OAI: oai:DiVA.org:uu-97403DiVA: diva2:172341
Available from: 2008-09-04 Created: 2008-09-04 Last updated: 2011-05-19Bibliographically approved
In thesis
1. Optimizing Chemotherapy in Childhood Acute Myeloid Leukemia
Open this publication in new window or tab >>Optimizing Chemotherapy in Childhood Acute Myeloid Leukemia
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite major advances in our understanding of the biology of childhood acute myeloid leukemia (AML) and the development of new cytotoxic drugs, the prognosis of long-term survival is still only 60-65 %.

In the present research, we studied the pharmacokinetics of drugs used in the induction therapy of childhood AML and performed in vitro drug sensitivity testing of leukemic cells from children with AML.

The aims of the studies were to correlate the results of the analysis to biological and clinical parameters and to identify subgroups of AML with specific drug sensitivity profiles in order to better understand why treatment fails in some patients and how therapy may be improved.

Blood samples were analysed to study the pharmacokinetics of doxorubicin (n=41), etoposide (n=45) and 6-thioguanine (n=50). Doxorubicin plasma concentration and total body clearance were correlated to the effect of induction therapy, and doxorubicin plasma concentration was an independent factor for complete remission, both in univariate and multivariate analysis including sex, age, and white blood cell count at diagnosis. For etoposide and 6-thioguanine no correlation was found between pharmacokinetics and clinical effect. Children with Down syndrome (DS) tended to reach higher blood concentrations of etoposide and thioguanine nucleotides, indicating that dose reduction may be reasonable to reach the same drug exposure as in children without DS.

Leukemic cells from 201 children with newly diagnosed AML, 15 of whom had DS, were successfully analysed for in vitro drug sensitivity by the fluorometric microculture cytotoxicity assay (FMCA). We found that samples from children with DS were highly sensitive to most drugs used in AML treatment. In non-DS children, the t(9;11) samples were significantly more sensitive to cytarabine (p=0.03) and doxorubicin (p=0.035) than other samples. The findings might explain the very favorable outcome reported in children with DS and t(9;11)-positive AML. A specific drug resistance profile was found for several other genetic subgroups as well. A detailed study of MLL-rearranged leukemia showed that cellular drug sensitivity is correlated both to partner genes and cell lineage, findings that support the strategy of contemporary protocols to include high-dose cytarabine in the treatment of patients with MLL-rearrangement, both in AML and acute lymphoblastic leukemia (ALL).

Our results indicate that drug resistance and pharmacokinetic studies may yield important information regarding drug response in different sub-groups of childhood AML, helping us to optimize future chemotherapy in childhood AML.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 85 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 364
childhood, acute myeloid leukemia, drug resistance, pharmacokinetics, chromosomal abnormalities, Down syndrome, MLL-rearrangement, t(9;11)
National Category
urn:nbn:se:uu:diva-9189 (URN)978-91-554-7249-8 (ISBN)
Public defence
2008-09-26, Hedstrandsalen, Akademiska Sjukhuset, ingång 70, Uppsala, 13:15
Available from: 2008-09-04 Created: 2008-09-04 Last updated: 2013-06-14Bibliographically approved

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