Comparison of Three Doses of Cytarabine Consolidation for Intermediate- and Adverse-risk Acute Myeloid Leukemia: Real World Evidence From Thai Acute Myeloid Leukemia Registry

Chanswangphuwana, Chantiya; Polprasert, Chantana; Owattanapanich, Weerapat; Kungwankiattichai, Smith; Rattarittamrong, Ekarat; Rattanathammethee, Thanawat; Limvorapitak, Wasithep; Saengboon, Supawee; Niparuck, Pimjai; Puavilai, Teeraya; Julamanee, Jakrawadee; Saelue, Pirun; Wanitpongpun, Chinadol; Nakhakes, Chajchawan; Prayongratana, Kannadit; Sriswasdi, Chantrapa

doi:10.1016/j.clml.2022.06.005

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Luca Maurillo reported that MRD negativity is not less in the standard-dose group as compared to high-dose cytarabine after both induction and consolidation [ 37 ]. Three doses of cytarabine consolidation (1.5 g/m2, 2 g/m 2 , and high-dose cytarabine (HiDAC) 3 g/m 2 ) were administered to intermediate- and poor-risk AML patients, and showed no significant differences in DFS and OS; however; septic shock was significantly higher after HiDAC 3 g/m 2 administration as compared to the IDAC regimen [ 38 ]. The present study indicated that MRD direction and HSCT selection in the PRT were vital for improving the survival of IR-AML patients.…”

Section: Discussionmentioning

confidence: 99%

Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1

Han

et al. 2022

Int J Hematol

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Objectives This study retrospectively investigated in which cycle measurable residual disease (MRD) is associated with prognosis in patients in first complete remission (CR1) of intermediate-risk acute myeloid leukemia (AML). Methods The study enrolled 235 younger patients with intermediate-risk AML. MRD was evaluated by multiparameter flow cytometry after the 1st, 2nd, and 3rd chemotherapy cycles (MRD1–3, respectively). Results No significant association was detected after the 1st and 2nd cycles. However, the 5-year incidence of relapse was higher in the MRD3-positive group (n = 99) than in the negative group (n = 136) (48.7% vs. 13.7%, P = 0.005), while 5-year disease-free survival (DFS) and overall survival (OS) were lower in the MRD3-positive group than in the negative group (43.2% vs. 81.0% and 45.4% vs. 84.1%; P = 0.003 and 0.005, respectively). Allogeneic hematopoietic stem cell transplantation led to a lower 5-year relapse, and higher DFS and OS rates than chemotherapy in the MRD3-positive group (22.3% vs. 71.5%, 65.9% vs. 23.0%, and 67.1% vs. 23.9%; P < 0.001, 0.002, and 0.022, respectively), but did not affect the MRD-negative group. Conclusions MRD3 could serve as an indicator for post-remission treatment choice and help improve outcomes for intermediate-risk AML in CR1.

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Section: Discussionmentioning

confidence: 99%

Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1

Han

et al. 2022

Int J Hematol

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“…No signi cant difference was seen between the two arms in our study. Overall, the incidence of febrile neutropenia was also less than that reported in similar setting [29,30,31].…”

Section: Discussionmentioning

confidence: 45%

“…The use of HIDAC for consolidation in AML is being super ceded by intermediate dose cytarabine [IDAC] worldwide [29,33,34]. However, IDAC too causes myelosuppression and resultant complications.…”

Section: Discussionmentioning

confidence: 99%

Single dose of peg GCSF compared with daily GCSF in de novo acute myeloid leukemia patients on high dose cytarabine consolidation chemotherapy (HIDAC)

Ghosh

2024

Preprint

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Background: Consolidation therapy with high dose cytarabine (HIDAC) for Acute Myeloid Leukemia (AML)is associated with significant neutropenia , resultant infections and associated morbidities. In this prospective study on de novo AML patients we attempted to compare efficacy of peg GCSF vs GCSF in ameliorating the duration and severity of neutropenia. Material and methods: Fifty eight cycles of HIDAC(1,3,5) from 20 patients were studied. Twenty four hours after the consolidation chemotherapy, patients were randomized to receive either once daily short-acting GCSF (5 µg/kg) or single dose of long acting peg GCSF(6mg/100 µg per kg). Results: The median duration of neutropenia and episodes of febrile neutropenia were 9.0 and 15 in the GCSF arm and 9.8 days and 17 in the peg GCSF arm, respectively (p >0.05).. Incidence of positive microbiological cultures and mean duration of hospital stay was similar in the two arms. Conclusion: The results of this study failed to show any difference in the incidence and duration of febrile neutropenia, incidence of infections and associated morbidities, with the use of GCSF compared to peg GCSF in patients of AML on HIDAC consolidation therapy.

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Medium-cumulative dose of cytarabine in consolidation therapy shows the greatest benefit in AML patients

Hao,

Ji,

Jin

et al. 2024

Holist Integ Oncol

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Background High-dose cytarabine (HDAC) is commonly used for consolidation therapy in young acute myeloid leukemia (AML) patients, but the dosage of cytarabine is still controversial in the clinic due to its obvious post-chemotherapy adverse effects. The aim of this study was to contrast the efficacy in different dose groups of cytarabine after consolidation therapy in Chinese AML patients. Methods AML patients treated with cytarabine consolidation at Qilu Hospital, Shandong University from January 2010 to September 2022 were retrospectively analyzed, from which 346 AML patients with relatively complete follow-up data were selected for this study. We compared the patients’ overall survival (OS) rate, relapse-free survival (RFS) rate, and hematologic adverse events in terms of their general characteristics, cytarabine consolidation therapy dose, consolidation course, 2022 European Leukemia Net (ELN) risk stratification, and transplantation. Results In AML patients under 60 years of age, the 5-year RFS rate with high-dose cytarabine consolidation therapy was superior to that of small-dose cytarabine (P = 0.024), while the 5-year RFS rate was comparable in the high-dose and intermediate-dose groups, and there was no obvious difference among the three groups in the 5-year OS rate (P > 0.05). OS and RFS of those given more than 3 courses of cytarabine consolidation therapy were better than those in the 1–2 courses group (P = 0.060, P = 0.040). OS and RFS were better in patients with cumulative dose of cytarabine ≥ 36g than in patients with cumulative dose < 36g (P < 0.05), but cumulative dose ≥ 54g was comparable in OS and RFS with ≥ 36–< 54g group (P > 0.05). There was no significant difference in hematologic adverse effects among the three treatment groups. In the latest ELN risk stratification favorable-risk group, the cumulative dose of cytarabine ≥ 36g had a better 5-year RFS rate than the < 36g group (P = 0.038), and in the intermediate-risk group the 5-year OS rate and RFS rate were better in the ≥ 36g group than the < 36g group (P = 0.012, 0.025). In addition, the prognosis of transplanted patients was better than that of non-transplanted patients, whereas in non-transplanted patients, consolidation therapy with ≥ 36g cytarabine can effectively improve outcomes. Multivariate analysis indicated that age, fibrinogen (FIB) and the cumulative dose of cytarabine of ≥ 36–< 54g were predictors of OS, while age, white blood cell (WBC) and HDAC were predictors of RFS. Conclusion The results of the study showed that consolidation therapy with cytarabine up to a cumulative dose of ≥ 36–< 54g in AML patients who did not undergo transplantation significantly improved patient prognosis. In the latest ELN risk stratification, cumulative doses of cytarabine ≥ 36g had a better prognosis in favorable and intermediate-risk patients.

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Comparison of Three Doses of Cytarabine Consolidation for Intermediate- and Adverse-risk Acute Myeloid Leukemia: Real World Evidence From Thai Acute Myeloid Leukemia Registry

Cited by 3 publications

References 19 publications

Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1

Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1

Single dose of peg GCSF compared with daily GCSF in de novo acute myeloid leukemia patients on high dose cytarabine consolidation chemotherapy (HIDAC)

Medium-cumulative dose of cytarabine in consolidation therapy shows the greatest benefit in AML patients

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