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Histamine Dihydrochloride

In the Management of Acute Myeloid Leukaemia

Drugs volume 71, pages 109–122 (2011)Cite this article

Abstract

Histamine dihydrochloride (Ceplene®) is a synthetic derivative of the biogenic amine histamine. Histamine dihydrochloride inhibits the formation of reactive oxygen species that suppress the activation of T cells and natural killer cells. When administered in addition to the cytokine interleukin (IL)-2, histamine dihydrochloride enables the activation of T cells and natural killer cells by IL-2, resulting in the killing of tumour cells of various cancers, including acute myeloid leukaemia (AML).

In a 3-year, randomized, multicentre, phase III trial in adult patients with AML in first or subsequent remission, those who received subcutaneous histamine dihydrochloride and concomitant subcutaneous IL-2 as maintenance therapy had a significantly longer leukaemia-free survival (LFS; primary endpoint) than recipients of no treatment. This difference was also shown for the subgroup of patients in first remission. The between-group difference in overall survival (OS) was not significant, although this trial was not powered to detect such a difference.

Histamine dihydrochloride and IL-2 therapy had an acceptable tolerability profile in patients in the phase III trial. The majority of reported adverse events were grade 1 or 2 of the National Cancer Institute Common Toxicity Criteria. The most commonly reported grade 3 adverse events with active treatment were thrombocytopenia, headache, neutropenia, pyrexia, eosinophilia and diarrhoea; grade 4 adverse events were thrombocytopenia and leukopenia not otherwise specified. Serious adverse events were mostly relapse related.

Histamine dihydrochloride and IL-2 as maintenance therapy significantly prolonged LFS compared with no treatment and had an acceptable tolerability profile in a large phase III trial in patients with AML. Although some issues remain to be addressed, most notably the effects of therapy on OS and the efficacy of treatment in older patients, histamine dihydrochloride in addition to IL-2 appears to be a useful maintenance therapy option for adult patients with AML in remission.

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  1. Adis, a Wolters Kluwer Business, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand

    Lily P. H. Yang & Caroline M. Perry

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  1. Lily P. H. Yang
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Correspondence to Lily P. H. Yang.

Additional information

Various sections of the manuscript reviewed by: T. Büchner, Department of Hematology and Oncology, University of Münster, Münster, Germany; G. Damaj, Department of Clinical Hematology, University Hospital of Amiens, Amiens, France; F. Ferrara, Division of Haematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples, Italy; M. Hamadani, Department of Medicine, West Virginia University, Morgantown, West Virginia, USA; J.E. Rubnitz, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA.

Data Selection

Sources: Medical literature published in any language since 1980 on ‘histamine dihydrochloride’, identified using MEDLINE and EMBASE, supplemented by AdisBase (a proprietary database). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: MEDLINE, EMBASE and AdisBase (a proprietary database) search terms were ‘histamine dihydrochloride’ or ‘histamine’ and ‘acute myeloid leukaemia’ or ‘acute myeloid leukemia’ or ‘AML’. Searches were last updated 7 December 2010.

Selection: Studies in patients with acute myeloid leukaemia who received histamine dihydrochloride. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic and pharmacokinetic data are also included.

Index terms: Histamine dihydrochloride, interleukin-2, acutemyeloid leukaemia, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability.

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Yang, L.P.H., Perry, C.M. Histamine Dihydrochloride. Drugs 71, 109–122 (2011). https://doi.org/10.2165/11206410-000000000-00000

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Keywords

  • Overall Survival
  • Histamine
  • Natural Killer Cell
  • Maintenance Therapy
  • Acute Myeloid Leukaemia