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Outcomes of HIDAC 18 g Versus IDAC 9 g in Consolidation Therapy of Acute Myeloid Leukemia: A Retrospective Study

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Background

Cytarabine based therapy has been the standard consolidation regimen for AML (acute myeloid leukemia) for decades. However, the optimal dose, regimen and schedule is not known. HIDAC (high dose cytarabine at 18 g/m2) has been the conventional standard, however, recent studies have shown that intermediate doses of cytarabine (IDAC) have equal efficacy and lesser toxicities.

Methods

We retrospectively analysed 75 AML patients who entered consolidation out of 167 patients who underwent induction therapy between 2014 and 2018. HIDAC (at 18 g/m2) was given to 39 patients and 36 patients received IDAC at 9 g/m2.

Results

Median age was 28 years (range 2–60). Male: female ratio was 1.02. More courses were administered in out-patient setting in IDAC group 61% (n = 58/95 courses) than in HIDAC 29% (n = 29/101 courses); p < 0.001. Incidence of clinically documented infection (CDI) was higher in HIDAC group (23.7%) compared to IDAC (8.4%), p = 0.004, and diarrhea showed a higher trend in the HIDAC group (9.9% vs. 3.1%; p = 0.052). Other toxicities were similar in both groups. There were 4 consolidation deaths in HIDAC whereas 3 deaths in IDAC group (p = 0.775). Median OS was 19.7 vs. 16.2 months and 3 years OS was 49.1% vs. 34.7% in HIDAC and IDAC groups respectively (p = 0.570). Median LFS was 12.6 versus 11.8 months; 3 years LFS was 46.4% versus 31% in HIDAC and IDAC groups respectively (p = 0.278).

Conclusion

For AML consolidation IDAC had lesser toxicity when compared with HIDAC though comparable efficacy needs to be confirmed with longer follow up and with prospective studies.

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Acknowledgements

Authors thank all the staffs of department of Medical Oncology for completion of this work. We acknowledge the contribution of JIPMER (Jawaharlal Institute of Postgraduate Medical Education and Research) for providing logistic support for this work.

Funding

No specific funding was involved in conduct of this retrospective study.

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Authors and Affiliations

  1. Department of Medical Oncology, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, 605006, India

    Dinesh Ravikumar, Honey Saju, Amit Choudary, Arnab Bhattacharjee, Biswajit Dubashi, Prasanth Ganesan & Smita Kayal

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  1. Dinesh Ravikumar
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  2. Honey Saju
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Contributions

Study conceptualization & methodology: SK, HS, DR, BD. Data collection and analysis: DR, HS, SK, AC, AB. Manuscript writing: DR, HS, AB, SK, PG. Review and editing: SK, HS, AC, BD, PG. Final approval of manuscript: by all authors.

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Correspondence to Smita Kayal.

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Institute Ethics approval was taken before commencement of the study.

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Waiver of consent was granted for the retrospective data and analysis.

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Ravikumar, D., Saju, H., Choudary, A. et al. Outcomes of HIDAC 18 g Versus IDAC 9 g in Consolidation Therapy of Acute Myeloid Leukemia: A Retrospective Study. Indian J Hematol Blood Transfus 38, 31–41 (2022). https://doi.org/10.1007/s12288-021-01430-z

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