Comparison of Three Doses of Cytarabine Consolidation for Intermediate- and Adverse-risk Acute Myeloid Leukemia: Real World Evidence From Thai Acute Myeloid Leukemia Registry |
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| Institution: | 1. Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand;2. Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand;3. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand;4. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.;5. Division of Hematology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand.;6. Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;7. Hematology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand;8. Hematology Unit, Department of Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand;9. Division of Hematology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand.;10. Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.;1. Yale University School of Medicine, New Haven CT, USA;2. University of Miami School of Medicine, Miami, Florida, USA;3. Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;4. Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA;5. Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA;1. Department of Internal Medicine, Cleveland Clinic Main Campus, Cleveland, OH;2. Sarah Cannon – Nashville TN;1. Clinical Hematology Oncology and HCT, Tata Medical Center, Kolkata, India;2. Laboratory Hematology and Molecular Pathology, Tata Medical Center, Kolkata, India;3. Nuclear Medicine, Tata Medical Center, Kolkata, India;4. Histopathology, Tata Medical Center, Kolkata, India;1. Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand;2. Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand;3. Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi hospital, Bangkok, Thailand;4. Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand;5. Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;1. Leukemia/BMT Program of BC, BC Cancer, Vancouver, BC, Canada;2. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada;3. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada;4. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada;5. Division of Infectious Diseases, Department of Medicine, University of Alberta, AB, Edmonton, Canada;6. Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada;7. Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute; Morsani College of Medicine, University of South Florida, Tampa, FL, USA |
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| Abstract: | BackgroundIntermediate or high doses of cytarabine (IDAC or HiDAC) were recommended as postremission chemotherapy for acute myeloid leukemia (AML). This retrospective study investigated the real-world outcomes of 3-different cytarabine doses from the multicenter Thai AML registry database.Patients and MethodsThe intermediate- and adverse-risk AML patients (N = 258) who achieved complete remission and proceeded to single-agent cytarabine consolidation were enrolled.ResultsThe median relapse-free survival (RFS) using IDAC 1.5 g/m2, high-dose cytarabine (HiDAC) 2 g/m2, and HiDAC 3 g/m2 were 12.6, 11.7, and 13 months, respectively. The median overall survival (OS) using IDAC 1.5 g/m2, HiDAC 2 g/m2, and HiDAC 3 g/m2 were 34.9, 22.7, and 23.7 months, respectively. No significant difference in RFS and OS was detected between the 3 doses. Secondary AML, white blood cell > 100×109/L and the adverse-risk AML were independent prognostic factors for inferior survival (P= .008, P < .001, P= .014). Patients who completed 3 to 4 cycles of consolidation had significantly superior RFS and OS (P< .001, P< .001). Febrile neutropenia occurred in 72.9% of IDAC, 73.8% of HiDAC 2 g/m2, and 78.1% of HiDAC 3 g/m2 without statistical significance. However, the incidence of septic shock was significantly higher after HiDAC 3 g/m2 compared to IDAC regimen (8% vs. 3%, P= .037).ConclusionIDAC is an appropriate regimen for postremission chemotherapy for intermediate- and adverse-risk AML. The higher dosing levels may not produce any benefits to patients and may increase incidence of septic shock. The number of consolidation cycles may impact on survivals rather than the intensity of cytarabine. |
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| Keywords: | Intermediate-risk acute myeloid leukemia Adverse-risk acute myeloid leukemia |
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