title: Increasing aclarubicin dosage of the conventional CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen is more efficacious as a salvage therapy than CAG for relapsed/refractory acute myeloid leukemia.
abstract: The efficacy and safety of a modified CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen with an increased aclarubicin dosage [high-dose (HD)-CAG] were observed in 145 patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) and compared to the results of 172 patients treated with a conventional CAG regimen. The HD-CAG regimen showed both a higher complete remission (CR) rate (60.7% vs. 46.5%, P=0.013) and overall response (OR) rate (74.5% vs. 63.4%, P=0.039) than CAG. For patients aged <60 years, HD-CAG manifested an efficacy advantage over the CAG regimen (62.6% vs. 47.4%, P=0.015). The 4-year overall survival (OS) rate was 30.3%±13.2% with a median survival time of 19.0±5.4 months for patients re-induced with the HD-CAG regimen, which showed no significant difference compared to the CAG regimen (with a 4-year OS rate of 18.2%±5.3% and a median survival time of 16.0±3.6 months, P=0.485). The main adverse effect was myelosuppression; platelet recovery over 50×10(9)/L was extended by the HD-CAG regimen (15 days vs. 10 days of the CAG regimen, P=0.003), which was tolerable and manageable. HD-CAG can safely improve efficacy compared to the CAG regimen and thus serves as an alternative treatment for R/R AML.
authors.affiliation: The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, National Clinical Key Subject Construction Project, Suzhou 215006, PR China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Qu
authors.affiliation: The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, National Clinical Key Subject Construction Project, Suzhou 215006, PR China.
authors.forename: Limin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Hematology, Huai'an Hospital Affiliated to Xuzhou Medical College, The Second People's Hospital of Huai'an City, Huai'an, Jiangsu Province 223002, PR China.
authors.forename: Yanming
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, National Clinical Key Subject Construction Project, Suzhou 215006, PR China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Li
authors.affiliation: The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, National Clinical Key Subject Construction Project, Suzhou 215006, PR China. Electronic address: wudepei@medmail.com.cn.
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
mesh_terms: D015250:Aclarubicin / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001855:Bone Marrow Diseases / Q000139:chemically induced; D009202:Cardiomyopathies / Q000139:chemically induced; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000139:chemically induced; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D015250:Aclarubicin
keywords: Acute myeloid leukemia; CAG protocol; Refractory; Relapse; Salvage therapy