Efficacy of common salvage chemotherapy regimens in patients with refractory or relapsed acute myeloid leukemia: A retrospective cohort study.

ABSTRACT: To assess treatment response and overall survival (OS) in refractory or relapsed acute myeloid leukemia (R/R AML) patients treated by different common salvage chemotherapy regimens.Medical records data from 142 R/R AML patients were reviewed in this retrospective study. Patients were treated with regimens based on the following drugs: cytarabine, granulocyte colony-stimulating factor (G-CSF), and fludarabine (FLAG) (n?=?46); cytarabine and G-CSF in addition to aclarubicin or daunorubicin (CAG/DAG) (n?=?30); cytarabine, G-CSF, and cladribine (CLAG) (n?=?27); cytarabine, etoposide, and mitoxantrone (MEA) (n?=?17); cytarabine plus idarubicin, daunorubicin, or mitoxantrone (IA/DA/MA) (n?=?12); and homoharringtonine, cytarabine, and aclarubicin or daunorubicin (HAA/HAD) (n?=?10).A total of 43 (35.2%) patients achieved complete remission (CR), 60 (49.2%) patients achieved overall remission rate (ORR), and 18 (14.8%) patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR. Median OS was 8.0 (95% CI 6.6-9.4) months with a 1-year OS rate of (29.9?±?3.9)% and 3-year OS rate of (11.1?±?3.6)%. No difference of CR (P?=?.621), ORR (P?=?.385), and allo-HSCT (P?=?.537) achievement was observed among different chemotherapy regimens. Interestingly, we observed that the CLAG-based regimen did not affect CR (P?=?.165), while it achieved a numerically higher ORR (P?=?.093) and was an independent factor for prolonged OS (P?=?.016). No other regimens were determined to be correlated with CR, ORR, or OS.FLAG-, CAG/DAG-, CLAG-, MEA-, IA/DA/MA- and HAA/HAD-based regimens were found to achieve similar CR rates, while the CLAG-based regimen achieved numerically higher ORR rates and significant favorable OS. Therefore, CLAG-based regimens should be a prioritized treatment option for R/R AML patients.

SUBMITTER: Xu J 

PROVIDER: S-EPMC6181529 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature