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Induction Chemotherapy With Intermediate-Dosed Cytarabine for High-Risk AML

By: Julia Fiederlein
Posted: Tuesday, October 5, 2021

Patients with secondary or treatment-related acute myeloid leukemia (AML) who underwent induction chemotherapy with intermediate-dosed cytarabine experienced a “satisfactory” response rate, according to Sebastian Scholl, MD, of Universitätsklinikum Jena, Germany, and colleagues. The results of this retrospective analysis, which were published in the Journal of Cancer Research and Clinical Oncology, also suggested that consolidation therapy with allogeneic stem cell transplantation (HSCT) after full- or reduced-intensity conditioning may further improve survival outcomes in this patient population.

The investigators focused on 110 patients with newly diagnosed secondary or treatment-related AML who underwent induction chemotherapy with intermediate-dosed cytarabine plus idarubicin (≤ 60 years) or mitoxantrone (> 60 years). The majority of patients who subsequently underwent allogeneic HSCT in first complete remission (76%) were administered a reduced-intensity conditioning regimen prior to transplantation.

An overall response rate of 83% was reported after induction chemotherapy with intermediate-dosed cytarabine; more than half of patients (63%) achieved complete remission. Infectious complications, including sepsis with the need for intensive care treatment (4.5%) and proven or probable invasive fungal disease (7.2%), were the most relevant nonhematologic toxicities reported during this study. The durations of relapse-free, event-free, and overall survival were 19, 10, and 15 months, respectively, in the whole cohort (P < .0001).

Patients who underwent allogeneic HSCT seemed to experience a significantly longer duration of overall survival than those who did not receive this treatment (46 vs. 9 months; P < .0001). The rates of transplantation-related mortality at 30 and 90 days after allogeneic HSCT were 0.9% and 1.8%, respectively. A total of 60 months after allogeneic HSCT, treatment with a reduced-intensity conditioning regimen resulted in an overall survival rate of 60%; the median duration of overall survival was not reached.

“Induction chemotherapy with intermediate-dosed cytarabine…followed by allogeneic HSCT provides a reasonable strategy for treatment of high-risk [patients with AML],” the investigators concluded.

Disclosure: The study authors reported no conflicts of interest.



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