Low dose metronomic chemotherapy in patients of acute myeloid leukemia

Background: Standard aggressive treatment of AML is expensive, requires significant supportive care (blood and platelet support) and toxic with significant morbidity and mortality. The metronomic approach refers to repetitive low doses of chemotherapy drugs and serves as one of the options of treatment for the patients who are unable to arrange the supportive care and those who are ineligible for intensive chemotherapy. Material and Methods: This is a hospital based observational single arm pilot study in which newly diagnosed 36 patients of AML who were unable to take standard aggressive chemotherapy were started on low dose metronomic chemotherapy and its effects evaluated over a period of 12 months. Results: Observed overall response rate (OR) was 21.87% (6.25% CR and 15.62% PR), mean survival was 3.58 months. 43.75% patients had non-hematological drug toxicities, 40.62% patients developed hematological toxicity, 3.12% developed hepatotoxicity and 9.32% patients developed febrile illness. Out of expired patients at the end of 1 year duration 70% died at their home with cause of death unidentified however rest 30% died in hospital (23% from bleeding and 7% from infection). On FACT-L questionnaire overall improvements were elicited in well being along with 43% improvement in additional concerns (including night sweats, pains, weight loss, tiredness). Conclusion: Data from our small study suggests that oral PEM metronomic chemotherapy for patients of AML with treatment possible on OPD basis itself appears to be an effective regimen with acceptable toxicities.