Prolonged administration of low-dose cytarabine and thioguanine in elderly patients with acute myeloid leukaemia (AML) achieves high complete remission rates and prolonged survival

• Published in: Leukemia & lymphoma Vol. 61; no. 4; pp. 831 - 839
• Main Authors: Arthur, Christopher, Jeffrey, Anthony, Yip, Eva, Katsioulas, Vicki, Nalpantidis, Anastasios, Kerridge, Ian, Greenwood, Matthew, Coyle, Luke, Mackinlay, Naomi, Fay, Keith, Enjeti, Anoop, Shortt, Jake, Stevenson, William
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 20-03-2020
• Subjects: acute myeloid leukemia; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; cytarabine; Cytarabine - therapeutic use; Humans; Leukemia, Myeloid, Acute - drug therapy; Low-dose chemotherapy; Neoplasm Recurrence, Local - drug therapy; Remission Induction; Retrospective Studies; thioguanine; Thioguanine - therapeutic use; Treatment Outcome; cytarabine; Low-dose chemotherapy; acute myeloid leukemia; thioguanine
• ISSN: 1042-8194; 1029-2403
• DOI: 10.1080/10428194.2019.1697876

The prognosis of AML in elderly patients is poor and research into novel therapeutic approaches is urgently needed. This study examined the use of low-dose chemotherapy with cytarabine and thioguanine administered in repetitive cycles in 62 elderly patients with newly diagnosed or relapsed/refractory AML. The overall response rate was 58% in the total cohort. Response rates (CR/CRi) were significantly higher in patients with newly diagnosed AML (74%) compared to patients with relapsed/refractory disease (25%, p = .0004). Kaplan-Meier estimate of overall survival was 289 days (95% CI; 183-395 days) with a relapse rate of 65.7%. The induction mortality rate was 16.1% with treatment successfully undertaken in the outpatient setting. Similar clinical outcomes were observed in a retrospective analysis of a second cohort of 25 AML patients treated at a different site. These results support the use of a sustained low intensity chemotherapy approach as a therapeutic option for elderly patients with AML.