In a phase I-II study, the authors evaluated the intracellular pharmacokinetics, toxicity, and efficiency of a high dose of
mitoxantrone given as first induction in acute non-
lymphocytic leukemia. Twenty-two patients with previously untreated de novo
ANLL were included and received 30 or 40 mg/m2
mitoxantrone on day 1 by
intravenous infusion over 1 hour and 500 mg/m2
ara-C twice a day for 5 days. If there was no complete remission (CR), a second induction with
ara-C,
etoposide, and
amsacrine was given. The CR rate after two courses with this regimen was 77%. Median duration of severe
neutropenia was 18 days in the 30-mg/m2 group and 25 days in the 40-mg/m2 group. Two patients had fatal lung complications probably unrelated to
mitoxantrone. A third patient had a possible
mitoxantrone-induced reversible lung complication. In the leukemic cells, we found a high accumulation of
mitoxantrone which, in contrast to the plasma concentration, remained stable during the 48 hours studied. Compared with previous results with 12 mg/m2
mitoxantrone, the AUC for intracellular concentrations versus time for the first 20 hours studied was increased by 150% to 0.638 nmol/mg cell
protein x hour with 30 mg/m2
mitoxantrone and by 260% to 1.103 nmol/mg cell
protein x hour with 40 mg/m2
mitoxantrone. In conclusion, a high dose of
mitoxantrone results in a high intracellular exposure of the leukemic cells, which may be an advantage in improving survival of these patients.