Efficacy And Toxicity Of Cyclophosphamide Combined With Cytarabine For Induction Chemotherapy In Adult Acute Myeloid Leukemia

[Objective]To investigate the impact of two protocols containing cyclophosphamide(CTX)combined with cytarabine(Ara-C)(CA4+3 regimen and CA4+5 regimen)applied for the treatment of adult acute myeloid leukemia.[Patients and Methods]We retrospectively analyzed 40 patients with AML who were treated with a combination of cyclophosphamide and cytarabine in the Institute of Hematology&Hospital of Blood Diseases,Chinese Academy of Medical Sciences&Peking Union of Medical College between January 2014 and March 2019.Two different protocols contained 20 patients respectively according to the administration frequencies of Ara-C:CA4+3 group(Ara-C:1g/m2,q12hx3d)and CA4+5 group(Ara-C:lg/m2,qd×5d).The efficacy of induction regimens and its influencing factors and adverse reactions were compared.[Results]?This study preliminarily investigated the effect of cyclophosphamide combined with cytarabine on induction chemotherapy of adult newly diagnosed acute myeloid leukemia(non-APL).A complete response(CR)rate induced by CA4+3 protocol was 80%(16/20)and overall response rate(ORR)of it was 80%(16/20).The CA4+5 group had a CR rate of 75%(15/20)and an ORR of 85%(17/20).There was no significant difference in ORR between the two groups(P=0.677).?Analysis of possible age,gender,pre-treatment peripheral blood leukocyte count,bone marrow blast cell count,cytogenetics and molecular genetic stratification did not show statistical difference in ORR(P>0.05).?The ANC recovery time of the CA4+3 group was earlier than that of the CA4+5 group,which was statistically significant(P=0.006),suggesting that the CA4+3 group may be earlier than the CA4+5 group in getting out of agranulocytosis after chemotherapy.?By Multivariate COX regression analysis,the poor prognosis of NCCN risk stratification may be of an independent prognostic factor(P=0.036).?Patients with non-hematologic adverse reactions were more common with infection.The incidence rate of adverse reactions in CA4+5 regimen was higher than that in CA4+3 group,but the difference was not statistically significant.[Conclusion]The protocols with a combination of cyclophosphamide and cytarabine represents a promising therapeutic approach to induce a first CR in untreated adult acute myeloid leukemia,and the CA4+3 protocol may be better.