title: A meta-analysis of CAG (cytarabine, aclarubicin, G-CSF) regimen for the treatment of 1029 patients with acute myeloid leukemia and myelodysplastic syndrome.
abstract: The regimen of cytarabine, aclarubicin and G-CSF (CAG) has been widely used in China and Japan for treatment of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We searched literature on CAG between 1995 and 2010 and performed a meta-analysis to determine its overall efficacy using a random-effects or fixed-effects model. Thirty five trials with a total of 1029 AML (n = 814) and MDS (n = 215) patients were included for analysis. The CR rate of AML (57.9%) was significantly higher than that of MDS (45.7%) (p < 0.01). No difference in CR was noted between the new (56.7%) and relapsed/refractory AML (60.1%) (p > 0.05). The CR rate was also significantly higher in patients with favorable (64.5%) and intermediate (69.6%) karyotypes than those with unfavorable one (29.5%) (p < 0.05). Remarkably, the CR rate of CAG was significantly higher than those of non-CAG regimens (odds ratio 2.43). CAG regimen was well tolerated, with cardiotoxicity in 2.3% and early death in 5.2% of the cases. In conclusion, CAG regimen was an effective and safe regimen for the treatment of AML, and may be more effective than non-CAG regimens. Randomized controlled trials are strongly recommended to evaluate its efficacy and safety in comparison with the current standard treatment.
authors.affiliation: Bone Marrow Transplantation Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. weiguoqing2000@sina.com
authors.forename: Guoqing
authors.initials: G
authors.lastname: Wei
authors.forename: Wanmao
authors.initials: W
authors.lastname: Ni
authors.forename: Jen-wei
authors.initials: JW
authors.lastname: Chiao
authors.forename: Zhen
authors.initials: Z
authors.lastname: Cai
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.forename: Delong
authors.initials: D
authors.lastname: Liu
mesh_terms: D015250:Aclarubicin / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D015250:Aclarubicin
references.citation: Lancet Oncol. 2009 Mar;10(3):223-32
references.pmid: 19230772
references.citation: Leuk Res. 2007 Oct;31(10):1383-8
references.pmid: 17420048
references.citation: N Engl J Med. 2009 Sep 24;361(13):1235-48
references.pmid: 19776405
references.citation: Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2008 Mar;33(3):245-51
references.pmid: 18382060
references.citation: Gan To Kagaku Ryoho. 2003 Aug;30(8):1113-8
references.pmid: 12938265
references.citation: Leukemia. 1992 Feb;6(2):100-6
references.pmid: 1372669
references.citation: Exp Hematol. 1991 May;19(4):267-72
references.pmid: 2055291
references.citation: Blood. 2009 Apr 30;113(18):4179-87
references.pmid: 19008455
references.citation: Int J Hematol. 2005 Jul;82(1):48-54
references.pmid: 16105759
references.citation: J Clin Oncol. 2003 Dec 15;21(24):4642-9
references.pmid: 14673054
references.citation: Leukemia. 1998 Sep;12 Suppl 1:S20-4
references.pmid: 9777890
references.citation: J Hematol Oncol. 2010 Nov 29;3:48
references.pmid: 21114827
references.citation: J Hematol Oncol. 2010 Feb 11;3:8
references.pmid: 20149254
references.citation: N Engl J Med. 2009 Sep 24;361(13):1249-59
references.pmid: 19776406
references.citation: J Hematol Oncol. 2009 Jul 30;2:32
references.pmid: 19642997
references.citation: Drugs Exp Clin Res. 1986;12(1-3):275-82
references.pmid: 3525076
references.citation: Leukemia. 1995 Jan;9(1):10-4
references.pmid: 7531259
references.citation: Int J Hematol. 2000 Apr;71(3):238-44
references.pmid: 10846828
references.citation: Leukemia. 2004 Jan;18(1):120-5
references.pmid: 14586477
references.citation: Blood. 1991 Nov 15;78(10):2520-6
references.pmid: 1824249
references.citation: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Jun;17(3):760-4
references.pmid: 19549403
references.citation: Rinsho Ketsueki. 1996 Aug;37(8):651-3
references.pmid: 8827872
references.citation: J Hematol Oncol. 2010 Oct 06;3:36
references.pmid: 20925957
references.citation: Rinsho Ketsueki. 1995 Mar;36(3):165-74
references.pmid: 7540220
references.citation: Leukemia. 1998 Sep;12 Suppl 1:S54-6
references.pmid: 9777898
references.citation: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Apr;17(2):459-63
references.pmid: 19379588
references.citation: Mutat Res. 2005 May 2;583(1):26-35
references.pmid: 15866463
references.citation: J Hematol Oncol. 2009 May 13;2:20
references.pmid: 19439093
references.citation: Pharmacol Rev. 2004 Jun;56(2):185-229
references.pmid: 15169927
references.citation: Leukemia. 2000 Mar;14(3):476-9
references.pmid: 10720145
references.citation: Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010 Apr;35(4):370-3
references.pmid: 20448361
references.citation: Leuk Res. 2010 May;34(5):610-4
references.pmid: 19744710
references.citation: Cancer. 2006 Mar 1;106(5):1099-109
references.pmid: 16435387
references.citation: J Hematol Oncol. 2010 Apr 23;3:17
references.pmid: 20416083
references.citation: Blood. 2000 Dec 15;96(13):4075-83
references.pmid: 11110676
references.citation: Rinsho Ketsueki. 1998 Mar;39(3):176-84
references.pmid: 9577640
references.citation: Br J Cancer. 1996 Dec;74(11):1719-29
references.pmid: 8956784
references.citation: J Hematol Oncol. 2009 Jun 02;2:23
references.pmid: 19490647
references.citation: Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2009 Aug;17(4):1061-3
references.pmid: 19698260
references.citation: Leukemia. 1990 Dec;4(12):826-34
references.pmid: 2243506