Man Wai Tang, Deborah Van der Tuin, Mesire Aydin, Jarom Heijmans, Arjan A. Van de Loosdrecht, Ellen Meijer, Caroline E. Rutten, Mariëlle Wondergem, Jeroen J. W. M. Janssen, Marjolein L. Donker, Mette D. Hazenberg, Sonja Zweegman, Bart J. Biemond, David C. De Leeuw, Erfan Nur
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Commonly used therapies are high dose cytarabine (HiDAC) and triple therapy consisting of fludarabine, cytarabine, and idarubicin combined with granulocyte colony-stimulating factor (FLAG-IDA).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Two patient cohorts with relapsed AML or HR-MDS treated with HiDAC or FLAG-IDA between October 2015 and December 2021 in two academic hospitals in the Netherlands were retrospectively analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Patients were treated with either HiDAC (n=22) or FLAG-IDA (n=25). Rates of CR (71% vs. 74%, P=0.85), 1-year OS (47% vs. 51%, P=0.99) and EFS (38% vs. 35%, P=0.71) were comparable between HiDAC and FLAG-IDA. Durations of neutropenia (median 24 days (IQR 20-26) vs. 30 days (IQR 22-39), P=0.014) and thrombocytopenia (22 days (IQR 17-26) vs. 36 days (IQR 26-53)) were significantly shorter in the HiDAC group than in the FLAG-IDA group.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>While remission rates and survival outcomes were similar, FLAG-IDA was associated with longer periods of myelosuppression and transfusion dependency compared to HiDAC in these two cohorts. 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De Leeuw, Erfan Nur\",\"doi\":\"10.1111/ejh.14370\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Relapsed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (HR-MDS) are associated with a poor prognosis. It is unknown which re-induction therapy provides the highest chance of durable remission. Commonly used therapies are high dose cytarabine (HiDAC) and triple therapy consisting of fludarabine, cytarabine, and idarubicin combined with granulocyte colony-stimulating factor (FLAG-IDA).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Two patient cohorts with relapsed AML or HR-MDS treated with HiDAC or FLAG-IDA between October 2015 and December 2021 in two academic hospitals in the Netherlands were retrospectively analyzed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Patients were treated with either HiDAC (n=22) or FLAG-IDA (n=25). Rates of CR (71% vs. 74%, P=0.85), 1-year OS (47% vs. 51%, P=0.99) and EFS (38% vs. 35%, P=0.71) were comparable between HiDAC and FLAG-IDA. Durations of neutropenia (median 24 days (IQR 20-26) vs. 30 days (IQR 22-39), P=0.014) and thrombocytopenia (22 days (IQR 17-26) vs. 36 days (IQR 26-53)) were significantly shorter in the HiDAC group than in the FLAG-IDA group.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>While remission rates and survival outcomes were similar, FLAG-IDA was associated with longer periods of myelosuppression and transfusion dependency compared to HiDAC in these two cohorts. 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引用次数: 0
摘要
背景：复发性急性髓性白血病（AML）和高危骨髓增生异常综合征（HR-MDS）与不良预后相关。目前尚不清楚哪种再诱导疗法能提供最高的持久缓解机会。常用的治疗方法是高剂量阿糖胞苷（HiDAC）和由氟达拉滨、阿糖胞苷和伊达柔比星联合粒细胞集落刺激因子（FLAG-IDA）组成的三联治疗。方法：回顾性分析2015年10月至2021年12月在荷兰两所学术医院接受HiDAC或FLAG-IDA治疗的两组复发性AML或HR-MDS患者。结果：患者接受HiDAC （n=22）或FLAG-IDA （n=25）治疗。在HiDAC和FLAG-IDA之间，CR （71% vs. 74%， P=0.85）、1年OS （47% vs. 51%， P=0.99）和EFS （38% vs. 35%， P=0.71）的比率具有可比性。HiDAC组中性粒细胞减少（中位24天（IQR 20-26） vs. 30天（IQR 22-39）， P=0.014）和血小板减少（22天（IQR 17-26） vs. 36天（IQR 26-53））的持续时间明显短于FLAG-IDA组。结论：虽然缓解率和生存结果相似，但在这两个队列中，与HiDAC相比，FLAG-IDA与更长时间的骨髓抑制和输血依赖相关。根据我们的研究，HiDAC可以被认为是复发性AML/HR-MDS的补救性化疗。
Comparison of HiDAC Versus FLAG-IDA in the Treatment of Relapsed Acute Myeloid Leukemia and High-Risk Myelodysplastic Syndrome
Background
Relapsed acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (HR-MDS) are associated with a poor prognosis. It is unknown which re-induction therapy provides the highest chance of durable remission. Commonly used therapies are high dose cytarabine (HiDAC) and triple therapy consisting of fludarabine, cytarabine, and idarubicin combined with granulocyte colony-stimulating factor (FLAG-IDA).
Methods
Two patient cohorts with relapsed AML or HR-MDS treated with HiDAC or FLAG-IDA between October 2015 and December 2021 in two academic hospitals in the Netherlands were retrospectively analyzed.
Results
Patients were treated with either HiDAC (n=22) or FLAG-IDA (n=25). Rates of CR (71% vs. 74%, P=0.85), 1-year OS (47% vs. 51%, P=0.99) and EFS (38% vs. 35%, P=0.71) were comparable between HiDAC and FLAG-IDA. Durations of neutropenia (median 24 days (IQR 20-26) vs. 30 days (IQR 22-39), P=0.014) and thrombocytopenia (22 days (IQR 17-26) vs. 36 days (IQR 26-53)) were significantly shorter in the HiDAC group than in the FLAG-IDA group.
Conclusion
While remission rates and survival outcomes were similar, FLAG-IDA was associated with longer periods of myelosuppression and transfusion dependency compared to HiDAC in these two cohorts. HiDAC can be considered as a salvage chemotherapyfor relapsed AML/HR-MDS based on our study.
期刊介绍：
European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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