A Retrospective Study Of Intermediate/High-dose Cytarabine Consolidation Therapy In Younger Adults With Acute Myeloid Leukemia With Favorable/Intermediate Risk Cytogenetics

Objective:To compare the long-term prognosis and safety among different doses, cumulative doses and cycles of cytarabine consolidation therapy in patients of acute myeloid leukemia (< 60) with favorable/intermediate risk cytogenetics.Method:142 newly diagnosed young patients (< 60) of AML (not include APL) between January 2010 and January 2015 were enrolled in our hospital. All patients were evaluated as favorable/intermediate risk cytogenetics, were in complete remission after one or two cycles of induction chemotherapy, and had at least one cycle of IDAC/HDAC. We retrospectively analyzed the clinical characteristics of the patients, including height, weight, chromosome, minimal residual disease and so on. Patients were divided into different groups, according to the doses, cumulative doses and cycles of cytarabine. The adverse effects and long-term prognosis including overall survival(OS), relapse-free survival (RFS) were compared among the different groups, and difference among the groups were assessed using standard statistic methods.Results:142 young patients were enrolled. (1) According to the doses,17 patients in IDAC-1 group (1.0 g/m~2/q12h～1.5g/m~2/q12h),71 patients in IDAC-2 group (1.6 g/m~2/q12h～1.9 g/m~2/q12h),54 patients in HDAC group (2.0 g/m~2/ql2h-3.0 g/m~2/q12h). HDAC group had a better OS, as compared with IDAC-1 group (p=0.014). In multivariable analysis, the dose was a potential prognostic factor of OS (P=0.078). (2) According to the accumulating doses,30 patients in low Ara-C accumulation group (<12 g/m~2),105 patients in intermediate Ara-C accumulation group (12 g/m~2/q12h～36g/m~2), 7 patients in high Ara-C accumulation group (≥36 g/m~2). Intermediate Ara-C accumulation group compared with low Ara-C accumulation group had an improvement in OS (p=0.018), and high Ara-C accumulation group compared with low Ara-C accumulation group, seems had better OS (p=0.076). In multivariable analysis the accumulation dose was the potential prognostic factor of OS (P=0.097). (3)According to the cycles,43 patients in 1 cycle group,72 patients in 2 cycles group,27 patients in 3+4 cycles group.3+4 cycles group had a higher RFS than 1 cycle group (p=0.035), and 2 cycles group (p=0.037). In multivariable analysis, the cycles of cytarabine was a potential prognostic factor of RFS (P=0.121). The adverse effects, relapse rate, early relapse rate, death rate were similar in the groups.Conclusions:For the young AML patients(<60 years older) with favorable/ intermediate risk cytogenetics, when choosing cytarabine for consolidation therapy after CR, with a dose over 1.5 g/m~2/q12h, and an accumulation dose over 12 g/m~2 have advantages on OS. And 3 cycles or more can improve RFS. The adverse effects were similar among different groups.