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Intravenous and Subcutaneous Cytarabine for Standard Induction Therapy in AML

By: Julia Fiederlein
Posted: Friday, January 22, 2021

The efficacy and safety of subcutaneous cytarabine for the treatment of acute myeloid leukemia (AML) appear to be comparable to those of the intravenous approach, according to Huafeng Wang, MD, of the Zhejiang University School of Medicine, Hangzhou, China, and colleagues. This multicenter noninferiority trial results were presented during the virtual edition of the 2020 American Society of Hematology (ASH) Annual Meeting and Exposition (Abstract 459).

“The ‘3+7’ regimen (anthracyclines plus cytarabine) is the first choice of induction chemotherapy in young adults with de novo AML, and cytarabine is always given by continuous intravenous infusion,” the investigators commented. “Subcutaneous injection of cytarabine offers a convenient and inexpensive alternative therapy to young adults with de novo AML.”

Patients were randomly assigned to receive idarubicin in combination with either intravenous or subcutaneous cytarabine (both, n = 120). After the first cycle of induction therapy, the rate of complete remission was 71.7% with subcutaneous cytarabine and 70.8% with intravenous cytarabine (P = .003). Complete remission was achieved by 77.5% and 75.8% of patients in the subcutaneous and intravenous injection groups, respectively, after the first two induction therapy cycles (P = .001).

The 3-year overall survival rate was 60% with subcutaneous cytarabine and 58% with intravenous cytarabine; after adjustments were made for sex, age, region, white blood cell counts, Eastern Cooperative Oncology Group performance status score, platelet counts, French-American-British subtype, integrated risk, and transplantation, a hazard ratio of 0.95 was reported. The 3-year event-free survival rates with subcutaneous and intravenous administration were 49% versus 44%, respectively; after adjustments were made, the hazard ratio was 0.84. The rates of hematologic toxicities, nonhematologic toxicities, and early death did not seem to differ between the treatment groups.

Disclosure: The study authors reported no conflicts of interest.  


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