Intermediate-dose cytarabine or standard-dose cytarabine plus single-dose anthracycline as post-remission therapy in older patients with acute myeloid leukemia: impact on health care resource consumption and outcomes

• Published in: Blood cancer journal (New York) Vol. 11; no. 11; pp. 180 - 4
• Main Authors: Galtier, Jean, Alric, Camille, Bérard, Emilie, Leguay, Thibaut, Tavitian, Suzanne, Bidet, Audrey, Delabesse, Eric, Rieu, Jean Baptiste, Vial, Jean-Philippe, Vergez, François, Lechevalier, Nicolas, Luquet, Isabelle, Klein, Emilie, de Grande, Anne-Charlotte, Sarry, Audrey, Pigneux, Arnaud, Récher, Christian, Bertoli, Sarah, Dumas, Pierre-Yves
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 13.11.2021; Springer Nature B.V; Nature Publishing Group
• Subjects: 631/67/1990/283/1897; 692/699/1541/1990/283/1897; Aged; Anthracyclines - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Correspondence; Cytarabine - administration & dosage; Female; Hematology; Humans; Leukemia, Myeloid, Acute - drug therapy; Life Sciences; Male; Middle Aged; Oncology; Registries; Remission Induction
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/s41408-021-00551-y

The treatment of older patients with newly diagnosed acute myeloid leukemia (AML) depends on their fitness. Fit patients receive an induction chemotherapy similar to that of younger patients to achieve complete remission (CR). In patients <60, post-remission treatment is based on repeated courses of intermediate-to high-dose cytarabine with or without allogeneic stem cell transplantation (SCT) according to relapse risk. For patients over 60, there is no consensus about such a strategy, and ELN recommendations suggest intermediate-dose cytarabine (IDAC) for 2–3 cycles in favorable-risk genetics, i.e., 20% of patients. For the remaining 80%, the value of intermediate dose compared to lower-dose cytarabine has not been demonstrated to date, so there is no recommendation in this setting. Nevertheless, IDAC is routinely used, especially in patients selected for allogeneic SCT or as a standard comparator in clinical trials. The IDAC regimen has been adapted to find a compromise between efficacy and toxicity from the results of the Cancer and Leukemia Group B (CALGB) phase 3 trial.