title: A low-dose cytarabine, aclarubicin and granulocyte colony-stimulating factor priming regimen versus a daunorubicin plus cytarabine regimen as induction therapy for older patients with acute myeloid leukemia: A propensity score analysis.
abstract: This retrospective analysis compared the efficacy of intensive induction therapy consisting of daunorubicin and cytarabine (DNR-AraC) to that of less-intensive therapy including low-dose cytarabine, aclarubicin and granulocyte colony-stimulating factor priming (CAG). Patients aged 60 years or older who were newly diagnosed as acute myeloid leukemia (AML) were analyzed. Sixty-four and 48 patients were treated with DNR-AraC and CAG, respectively. The complete remission rates, 3-year overall survival and event-free survival in the DNR-AraC group were significantly superior to those in the CAG group (65.6% vs. 29.2%, p<0.001, 38.4% vs. 12.3%, p=0.0033, and 20.3% vs. 7.8%, p=0.0030, respectively), although these differences were not statistically significant in multivariate analyses. Next, we calculated a propensity score for selecting the CAG regimen from six factors. The DNR-AraC regimen was associated with better survival than the CAG regimen in a low propensity score group, but there was no difference in survival between regimens in a high propensity score group. Intensive therapy should be performed for patients with sufficient general and comorbid conditions, but less-intensive therapy may be sufficient for patients with higher age, myelodysplasia-related changes, and lower white blood cell counts, which were relevant factors in the propensity score calculation.
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Minakata
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ito
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Mashima
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kento
authors.initials: K
authors.lastname: Umino
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Yamamoto
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Hatano
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Okazuka
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Iekuni
authors.initials: I
authors.lastname: Oh
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohmine
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Muroi
authors.affiliation: Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan. Electronic address: ycanda-tky@umin.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D015250:Aclarubicin / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D015250:Aclarubicin; D003630:Daunorubicin
keywords: Acute myeloid leukemia; Induction therapy; Older patients; Propensity score