title: High-dose cytarabine in acute myeloid leukemia treatment: a systematic review and meta-analysis.
abstract: The optimal dose, scheme, and clinical setting for Ara-C in acute myeloid leukemia (AML) treatment remain uncertain. In this study, we performed a meta-analysis to systematically assess the impact of high-dose cytarabine (HDAC) on AML therapy during the induction and consolidation stages. Twenty-two trials with a total of 5,945 de novo AML patients were included in the meta-analysis. Only patients less than 60 year-old were included in the study. Using HDAC in induction therapy was beneficial for RFS (HR = 0.57; 95% CI, 0.35-0.93; P = 0.02) but not so for CR rate (HR = 1.01; 95% CI, 0.93-1.09; P = 0.88) and OS (HR = 0.83; 95% CI, 0.66-1.03; P = 0.1). In consolidation therapy, HDAC showed significant RFS benefits (HR = 0.67; 95% CI, 0.49-0.9; P = 0.008) especially for the favorable-risk group (HR = 0.38; 95% CI, 0.21-0.69; P = 0.001) compared with SDAC (standard dose cytarabine), although no OS advantage was observed (HR = 0.84; 95% CI, 0.55-1.27; P = 0.41). HDAC treatment seemed less effective than auto-BMT/allo-BMT treatment (HR = 1.66, 95% CI, 1.3-2.14; P<0.0001) with similar OS. HDAC treatment led to lower relapse rate in induction and consolidation therapy than SDAC treatment, especially for the favorable-risk group. Auto-BMT/allo-BMT was more beneficial in prolonging RFS than HDAC.
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Xiaoyuan
authors.initials: X
authors.lastname: Gong
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Sun
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Xingli
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Benfa
authors.initials: B
authors.lastname: Gong
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wei
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Yingchang
authors.initials: Y
authors.lastname: Mi
authors.affiliation: Leukemia Diagnosis and Treatment Center, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China; State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union of Medical College, Tianjin, China.
authors.forename: Jianxiang
authors.initials: J
authors.lastname: Wang
mesh_terms: D002986:Clinical Trials as Topic; D003561:Cytarabine / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000473:pathology; D012074:Remission Induction
chemical_list: D003561:Cytarabine