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Modified cladribine, cytarabine, and G-CSF as a salvage regimen in patients with relapsed/refractory acute myeloid leukemia: a bridge to myeloablative allogeneic hematopoietic stem cell transplantation

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Abstract

Patients with primary refractory or early relapsed acute myeloid leukemia (AML) have a dismal prognosis, and the treatment options for these patients are limited. The present study retrospectively examined the efficacy and toxicities of the combination of cladribine 5 mg/m2 per day and intermediate-dose cytarabine 1 g/m2 per day for 5 days and granulocyte colony–stimulating factor (G-CSF) as a salvage treatment in 36 patients with relapsed/refractory AML. Among these, 32 patients had de novo AML, and the remaining 4 patients had secondary AML. The median age for the study cohort was 45.8 years. According to the European LeukemiaNet prognostic index, 5 patients had favorable risk, 18 had intermediate risk, and 11 had poor risk. The complete remission was achieved in 58% of the patients with tolerable toxicities. Fifteen patients underwent stem cell transplantation later. Patients who underwent allogeneic hematopoietic stem cell transplantation had a significantly improved 1-year overall survival compared with those who did not (73% vs. 29%, P < 0.001). The results suggested that, as a salvage regimen, modified cladribine, cytarabine, and G-CSF were effective and well tolerated for patients with relapsed/refractory AML, especially for patients who underwent subsequent stem cell transplantation.

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Acknowledgments

The authors appreciate the assistance of Chao Hu in collecting and preliminarily processing specimens from some patients and the contribution of Feifei Chen in revising and correcting the manuscript.

Funding

This study was funded by the National Natural Science Foundation of China (81500127), the Zhejiang Provincial Medical and Health Science and Technology Project (2017KY144), and the Ningbo Yinzhou District Social and Development project (YZ2015-96), China.

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Authors and Affiliations

  1. Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, No. 251, East Baizhang Road, Yinzhou District, Ningbo, 315040, Zhejiang, China

    Peipei Ye, Renzhi Pei, Kongfei Li, Junjie Cao, Dandan Zhou & Ying Lu

  2. Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China

    Jie Jin & Jie Sun

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  1. Peipei Ye
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Correspondence to Ying Lu.

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This study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the ethics committee of the institution.

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Ye, P., Pei, R., Jin, J. et al. Modified cladribine, cytarabine, and G-CSF as a salvage regimen in patients with relapsed/refractory acute myeloid leukemia: a bridge to myeloablative allogeneic hematopoietic stem cell transplantation. Ann Hematol 98, 2073–2080 (2019). https://doi.org/10.1007/s00277-019-03723-w

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