A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML
Abstract. The proportion of patients with acute myeloid leukemia (AML) cured is increased by administering high-dose cytarabine (HiDAC). It remains uncertain whether to administer HiDAC as induction or consolidation, and whether ≥1 cycle of HiDAC is required. Our retrospective study of 416 adult AML...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-12-01
|
| Series: | HemaSphere |
| Online Access: | http://journals.lww.com/10.1097/HS9.0000000000000158 |
| _version_ | 1827333051901804544 |
|---|---|
| author | Anthony P. Schwarer Jason Butler Kathryn Jackson Ashanka Beligaswatte Louisa Martin Glen Kennedy Zantomio Daniela Ian Lewis Devendra Hiwase Joel Wight Simon He Andrew Grigg Kirk Morris Peter Mollee Paula Marlton |
| author_facet | Anthony P. Schwarer Jason Butler Kathryn Jackson Ashanka Beligaswatte Louisa Martin Glen Kennedy Zantomio Daniela Ian Lewis Devendra Hiwase Joel Wight Simon He Andrew Grigg Kirk Morris Peter Mollee Paula Marlton |
| author_sort | Anthony P. Schwarer |
| collection | DOAJ |
| description | Abstract. The proportion of patients with acute myeloid leukemia (AML) cured is increased by administering high-dose cytarabine (HiDAC). It remains uncertain whether to administer HiDAC as induction or consolidation, and whether ≥1 cycle of HiDAC is required. Our retrospective study of 416 adult AML patients, excluding good risk cytogenetics, compared a single cycle of HiDAC-based therapy followed by 2 cycles of standard-dose cytarabine (SDAC) (HiDAC induction cohort) with SDAC-based chemotherapy followed by 2 cycles of HiDAC-based chemotherapy (HiDAC consolidation cohort). Complete remission (CR) rate was greater in the HiDAC induction cohort (90% vs 78%, P < 0.01) which did not lead to an improved overall survival (48% vs 43%, P = 0.18) or disease-free survival (DFS) (39% vs 45%, P = 0.95). We noted that, after censoring for allogeneic hematopoetic stem cell transplant (alloHSCT) in CR1, the cumulative incidence of relapse was lower in the HiDAC consolidation cohort in patients with intermediate risk cytogenetics (68% vs 44%, P = 0.01), which lead to a greater DFS (30% vs 47%, P = 0.095). In the patients with adverse risk cytogenetics, the RR was numerically greater in the HiDAC consolidation cohort (52% vs 80%, P = 0.60) which lead to a lower DFS (27% vs 4%, P = 0.11). Our data show that, although the HiDAC induction cohort (1 cycle of HiDAC) achieved a greater CR rate, there were no overall survival differences between the 2 cohorts, and that the HiDAC consolidation cohort (2 cycles of HiDAC) had a lower RR and greater DFS in those patients with intermediate risk cytogenetics who did not undergo alloHSCT in CR1. |
| first_indexed | 2024-03-07T17:13:11Z |
| format | Article |
| id | doaj.art-a833d18f98a24370b143cc52f3a42cf3 |
| institution | Directory Open Access Journal |
| issn | 2572-9241 |
| language | English |
| last_indexed | 2024-03-07T17:13:11Z |
| publishDate | 2018-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | HemaSphere |
| spelling | doaj.art-a833d18f98a24370b143cc52f3a42cf32024-03-03T00:26:18ZengWileyHemaSphere2572-92412018-12-012610.1097/HS9.0000000000000158201812000-00008A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AMLAnthony P. SchwarerJason ButlerKathryn JacksonAshanka BeligaswatteLouisa MartinGlen KennedyZantomio DanielaIan LewisDevendra HiwaseJoel WightSimon HeAndrew GriggKirk MorrisPeter MolleePaula MarltonAbstract. The proportion of patients with acute myeloid leukemia (AML) cured is increased by administering high-dose cytarabine (HiDAC). It remains uncertain whether to administer HiDAC as induction or consolidation, and whether ≥1 cycle of HiDAC is required. Our retrospective study of 416 adult AML patients, excluding good risk cytogenetics, compared a single cycle of HiDAC-based therapy followed by 2 cycles of standard-dose cytarabine (SDAC) (HiDAC induction cohort) with SDAC-based chemotherapy followed by 2 cycles of HiDAC-based chemotherapy (HiDAC consolidation cohort). Complete remission (CR) rate was greater in the HiDAC induction cohort (90% vs 78%, P < 0.01) which did not lead to an improved overall survival (48% vs 43%, P = 0.18) or disease-free survival (DFS) (39% vs 45%, P = 0.95). We noted that, after censoring for allogeneic hematopoetic stem cell transplant (alloHSCT) in CR1, the cumulative incidence of relapse was lower in the HiDAC consolidation cohort in patients with intermediate risk cytogenetics (68% vs 44%, P = 0.01), which lead to a greater DFS (30% vs 47%, P = 0.095). In the patients with adverse risk cytogenetics, the RR was numerically greater in the HiDAC consolidation cohort (52% vs 80%, P = 0.60) which lead to a lower DFS (27% vs 4%, P = 0.11). Our data show that, although the HiDAC induction cohort (1 cycle of HiDAC) achieved a greater CR rate, there were no overall survival differences between the 2 cohorts, and that the HiDAC consolidation cohort (2 cycles of HiDAC) had a lower RR and greater DFS in those patients with intermediate risk cytogenetics who did not undergo alloHSCT in CR1.http://journals.lww.com/10.1097/HS9.0000000000000158 |
| spellingShingle | Anthony P. Schwarer Jason Butler Kathryn Jackson Ashanka Beligaswatte Louisa Martin Glen Kennedy Zantomio Daniela Ian Lewis Devendra Hiwase Joel Wight Simon He Andrew Grigg Kirk Morris Peter Mollee Paula Marlton A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML HemaSphere |
| title | A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML |
| title_full | A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML |
| title_fullStr | A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML |
| title_full_unstemmed | A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML |
| title_short | A Comparison of High-Dose Cytarabine During Induction Versus Consolidation Therapy in Newly Diagnosed AML |
| title_sort | comparison of high dose cytarabine during induction versus consolidation therapy in newly diagnosed aml |
| url | http://journals.lww.com/10.1097/HS9.0000000000000158 |
| work_keys_str_mv | AT anthonypschwarer acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT jasonbutler acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT kathrynjackson acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT ashankabeligaswatte acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT louisamartin acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT glenkennedy acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT zantomiodaniela acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT ianlewis acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT devendrahiwase acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT joelwight acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT simonhe acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT andrewgrigg acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT kirkmorris acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT petermollee acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT paulamarlton acomparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT anthonypschwarer comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT jasonbutler comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT kathrynjackson comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT ashankabeligaswatte comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT louisamartin comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT glenkennedy comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT zantomiodaniela comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT ianlewis comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT devendrahiwase comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT joelwight comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT simonhe comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT andrewgrigg comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT kirkmorris comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT petermollee comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml AT paulamarlton comparisonofhighdosecytarabineduringinductionversusconsolidationtherapyinnewlydiagnosedaml |