MEC Regimen in AML
Definition
- MEC = Mitoxantrone + Etoposide + Cytarabine
- Used primarily as salvage/reinduction therapy in relapsed or refractory AML.
- Considered intensive chemotherapy, usually for fit patients.
Components & Dosing (typical adult regimen)
| Drug | Dose | Schedule / Notes |
|---|---|---|
| Mitoxantrone | 8–12 mg/m² IV | Days 1–5 |
| Etoposide | 100 mg/m² IV | Days 1–5 |
| Cytarabine (Ara-C) | 1–2 g/m² IV | Days 1–5 (sometimes high-dose) |
Doses vary by protocol and patient fitness; dose adjustments are needed for renal/hepatic dysfunction.
Clinical Use
- Indication: Relapsed/refractory AML (after standard 7+3 induction).
- Sometimes used as a bridge to allogeneic HSCT if remission achieved.
- Can be combined with other agents in investigational protocols.
Toxicity / Monitoring
- Myelosuppression: profound neutropenia and thrombocytopenia → infection/bleeding risk
- Mucositis, GI toxicity
- Cardiac toxicity: from mitoxantrone (monitor LVEF)
- Hepatic/renal function: monitor for dose adjustments
- TLS risk: high in patients with bulky disease → monitor LDH, uric acid, electrolytes
Key Pharmacy Points
- Salvage therapy: MEC is not first-line induction; reserved for relapse/refractory AML.
- High-intensity regimen: requires hospitalization, supportive care (antimicrobials, transfusions).
- Monitor organ function and cytopenias closely before each cycle.
- Bridge to HSCT: Goal is to achieve remission before transplant in eligible patients.
Takeaway:
In AML, MEC = Mitoxantrone + Etoposide + Cytarabine, an intensive salvage chemotherapy regimen for relapsed/refractory disease, not an antiemetic category.