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Comparing AML Induction Regimens After Failure of Hypomethylating Agents

By: Jenna Carter, PhD
Posted: Monday, August 3, 2020

Responses tend to be suboptimal in patients with secondary acute myeloid leukemia (AML) whose disease progresses after treatment failure of hypomethylating agents. However, studies suggest that high-dose cytarabine–based regimens may achieve better outcomes. In a recent study published in Leukemia Research, Kendra Sweet, MD, of the Moffitt Cancer Center, Tampa, Florida, and colleagues showed higher complete response rates and improved overall survival with high-dose cytarabine regimens compared with the standard 7+3 induction regimens.

A total of 241 patients were recruited and separated into 3 groups based on induction regimen. Group A (n = 114) received a combination of cladribine, cytarabine, filgrastim, and mitoxantrone; group B (n = 93) received the standard 7+3 chemotherapy; and group C (n = 34) received liposomal cytarabine-daunorubicin (CPX-351). They assessed responses according to the International Working Group criteria and determined complete response rates using bone marrow biopsy and aspirate as well as the peripheral blood cell counts at the time of biopsy.

Their findings revealed a significant difference in complete response rates between groups A (53%) and B (32%; P = .005); however, there were no differences between groups A and C (P = .329) and B and C (P = .402). Patients in group C had an overall response rate (complete response/complete response with incomplete blood cell count recovery) of 41.2%, compared with 53% in group A and 32% in group B. Despite the differences in response rates, there appeared to be no differences in median overall survival among the three groups (P = .887), as well as no differences in early death rates (P = .20).

“The results of this study suggest that [cytarabine-based regimens] may provide superior outcomes to 7+3 in patients with secondary acute myeloid leukemia,” concluded Dr. Sweet and colleagues.

Disclosure: The authors reported no conflicts of interest.


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