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Comparison of consolidation strategies in acute myeloid leukemia: high-dose cytarabine alone versus intermediate-dose cytarabine combined with anthracyclines

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Abstract

We compared the efficacy of high-dose cytarabine alone to that of intermediate-dose cytarabine combined with anthracyclines as consolidation therapy. Patients enrolled in the Korea University acute myeloid leukemia (AML) registry received remission induction chemotherapy with the same standard induction regimen (idarubicin and cytarabine 3 + 7). Postremission therapy was performed for three or four cycles according to one of the following regimens: high-dose cytarabine (3 g/m2) or combination of intermediate-dose cytarabine (1 g/m2) with anthracyclines (idarubicin or mitoxantrone). Among the 443 AML patients enrolled in the registry, 145 patients received consolidation chemotherapy. The median overall survival (OS) and relapse-free survival (RFS) in the high-dose cytarabine group were significantly longer than those in the anthracycline combination group (OS, not reached vs. 16.6 months, p = 0.045; RFS, 38.6 months vs. 11.0 months, p = 0.011). The median duration of neutropenia was longer in the anthracycline combination group than in the high-dose cytarabine group (8 vs. 10 days, p = 0.001). This study suggests that high-dose cytarabine consolidation may produce superior outcomes than combination treatment with intermediate-dose cytarabine and anthracyclines and that the addition of anthracyclines during AML consolidation has limited value as compared to cytarabine intensification.

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Acknowledgments

This work was supported by the Korea University Grant (K1133661).

Author contributions

DSK contributed as first authors. YP and CWC designed the study. DSK, KWK, SRL, YP, HJS, SJK, and CWC collected the data. DSK and YP analyzed and interpreted the data. DSK wrote the manuscript. YP and CWC reviewed the manuscript and contributed as co-corresponding authors.

Conflict of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Internal Medicine, Korea University School of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, Republic of Korea

    Dae Sik Kim, Ka-Won Kang, Se Ryeon Lee, Yong Park, Hwa Jung Sung, Chul Won Choi & Byung Soo Kim

  2. Division of Hematology-Oncology, Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Seok Jin Kim

  3. Division of Hematology-Oncology, Department of Internal Medicine, Korea University School of Medicine, 148 Guro-dong-ro, Guro-gu,, Seoul, 152-703, Republic of Korea

    Chul Won Choi

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  1. Dae Sik Kim
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  2. Ka-Won Kang
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Correspondence to Yong Park or Chul Won Choi.

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Kim, D.S., Kang, KW., Lee, S.R. et al. Comparison of consolidation strategies in acute myeloid leukemia: high-dose cytarabine alone versus intermediate-dose cytarabine combined with anthracyclines. Ann Hematol 94, 1485–1492 (2015). https://doi.org/10.1007/s00277-015-2389-9

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  • DOI: https://doi.org/10.1007/s00277-015-2389-9

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