Comparison of Three Doses of Cytarabine Consolidation for Intermediate- and Adverse-risk Acute Myeloid Leukemia: Real World Evidence From Thai Acute Myeloid Leukemia Registry

The real-world outcomes of 3-different cytarabine doses for consolidation treatment in acute myeloid leukemia were investigated. The survival efficacy showed no difference between 3 dosing levels (1.5 g/m2, 2 g/m2, and 3 g/m2). However, the incidence of septic shock was significantly higher after high dose cytarabine (3 g/m(2)). Intermediate dose of cytarabine is an appropriate regimen for intermediate- and adverse-risk acute myeloid leukemia. Background: Intermediate or high doses of cytarabine (IDAC or HiDAC) were recommended as postremission chemotherapy for acute myeloid leukemia (AML). This retrospective study investigated the real-world outcomes of 3different cytarabine doses from the multicenter Thai AML registry database. Patients and Methods: The intermediateand adverse-risk AML patients (N = 258) who achieved complete remission and proceeded to single-agent cytarabine consolidation were enrolled. Results: The median relapse-free survival (RFS) using IDAC 1.5 g/m2, high-dose cytarabine (HiDAC) 2 g/m(2), and HiDAC 3 g/m(2) were 12.6, 11.7, and 13 months, respectively. The median overall survival (OS) using IDAC 1.5 g/m(2), HiDAC 2 g/m (2), and HiDAC 3 g/m(2) were 34.9, 22.7, and 23.7 months, respectively. No significant difference in RFS and OS was detected between the 3 doses. Secondary AML, white blood cell > 100x109 /L and the adverse-risk AML were independent prognostic factors for inferior survival (P=.008, P <.001, P=.014). Patients who completed 3 to 4 cycles of consolidation had significantly superior RFS and OS (P<.001, P<.001). Febrile neutropenia occurred in 72.9% of IDAC, 73.8% of HiDAC 2 g/m(2), and 78.1% of HiDAC 3 g/m2 without statistical significance.