Comparison of Clinical Efficacy of Cytarabine with Different Regimens in Postremission Consolidation Therapy for Adult t(8;21) AML Patients: A Multicenter Retrospective Study in China

Abstract

Background: The survival of patients with acute myeloid leukemia (AML) with t(8;21) was reported to be shorter in China than in other countries. Patients: We analyzed the correlation between different cytarabine (Ara-c) regimens and outcome in 255 t(8;21) AML patients in China who received postremission consolidation chemotherapy only. Results: The 5-year overall survival (OS) of the high-dose Ara-c group (HDAC; 2≤ Ara-c ≤3 g/m²), intermediate-dose Ara-c group (MDAC; 1.0≤ Ara-c <2.0 g/m²), low-dose Ara-c group (LDAC; 0.2< Ara-c <1.0 g/m²) and standard-dose Ara-c group (SDAC; 0.1≤ Ara-c ≤0.2 g/m²) were 65.3, 39.4, 25.2 and 27.9%, respectively (p = 0.003). In the HDAC group, but not in the MDAC group, the 5-year OS of patients who achieved 3-4 cycles of chemotherapy was superior to those who underwent 1-2 cycles (84.4 vs. 43.6%, p < 0.05), and the 3-year OS of patients who achieved an accumulated 36 g/m² of Ara-c was significantly higher compared to those who did not (85.3 vs. 39.2%, p < 0.05). Multivariate analysis indicated that factors such as WBC >3.5 × 10⁹/l, PLT ≤30 × 10⁹/l, and extramedullary infiltration were associated with a poor prognosis. Conclusion: The survival of t(8;21) AML patients treated with high-dose Ara-c (≥2 g/m²) was superior to other dose levels in postremission consolidation chemotherapy. Patient survival was improved by 3-4 cycles of chemotherapy with an accumulated concentration of 36 g/m² of Ara-c. WBC >3.5 × 10⁹/l, PLT ≤30 × 10⁹/l and extramedullary infiltration could be indicative of a poor clinical prognosis.

Efficacy and safety of consolidation therapy with intermediate and high dose cytarabine in acute myeloid leukemia patients

“…However, the study of CALGB and JALSG AML201 was designed to compare HiDAC and SDAC (with [18] or without other chemotherapy [8,17]), not directly comparable to IDAC. While the retrospective study in AML with t (8;21) revealed the RFS and OS benefit of HiDAC over IDAC and SDAC [19], this study could not provide adequate information about this aspect because there were only five AML patients with favorable cytogenetic.…”

“…There were controversial issues regarding using IDAC as consolidation therapy in all AML patients. The analysis from CALGB study [17], Japan Adult Leukemia Study Group (JALSG) AML201 study [18], a retrospective study [19] and meta-analysis [11] supported the use of HiDAC in favorable risk cytogenetic patients including core-binding factor AML at least in terms of DFS or RFS. However, the study of CALGB and JALSG AML201 was designed to compare HiDAC and SDAC (with [18] or without other chemotherapy [8,17]), not directly comparable to IDAC.…”

The prognostic benefit from intermediate-dose cytarabine as consolidation therapy varies by cytogenetic subtype in t(8;21) acute myeloid leukemia: a retrospective cohort study

“…In t(8;21) AML, additional cytogenetic abnormalities were detected in more than 70% of patients (15)(16)(17). The additional cytogenetic aberrations have substantial influence on prognosis and clinical outcomes (18)(19)(20)(21)(22). In our previous studies, t (8;21) AML patients with additional -Y could not benefit from HiDAC regimen (1.5-3 g/m 2 /12 h) (23), whereas for patients with additional -X, the HiDAC regimen was suitable (24).…”