title: Comparison of cladribine- and fludarabine-based induction chemotherapy in relapsed or refractory acute myeloid leukaemia.
abstract: Induction regimens integrating cladribine or fludarabine have shown promising outcomes in relapsed or refractory (R/R) acute myeloid leukaemia (AML). We compared the outcome of a cladribine- versus a fludarabine-based regimen as induction chemotherapy for R/R-AML. We included patients with R/R-AML who were treated with a cladribine- or fludarabine-based chemotherapy between 2006 and 2015. We analysed 120 patients, 65 treated with cladribine and 55 treated with fludarabine. The CR rates were 62.7 and 61.4 % for the cladribine group and fludarabine group, respectively (p = 0.890). Poor prognostic factors included older age, secondary AML, poor cytogenetic risk group, prior induction failure, and short first CR duration. No significant overall survival (OS) or relapse-free survival (RFS) differences were found between the groups (OS, p = 0.213; RFS, p = 0.143). However, in a certain subset, survival outcomes were better with cladribine than with fludarabine, including de novo AML, CR at first induction therapy, and not-poor cytogenetic risk group inclusion without overt chemotherapy-refractoriness. By contrast, secondary AML patients had improved survival outcomes when treated with the fludarabine regimen. After CR, better outcomes were observed when allogeneic stem cell transplantation (SCT) was given as consolidation. In R/R-AML, cladribine- and fludarabine-based combination induction chemotherapy had differential survival outcomes according to disease characteristics. Allogeneic SCT after CR with a purine analogue-based regimen improved long-term outcome in these patients.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Hyunkyung
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Youk
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea.|Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea.|Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.|Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea.|Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Jeong-Ok
authors.initials: JO
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Soo-Mee
authors.initials: SM
authors.lastname: Bang
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, 101 Daehag-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. go01@snu.ac.kr.|Cancer Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea. go01@snu.ac.kr.|Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. go01@snu.ac.kr.
authors.forename: Youngil
authors.initials: Y
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D017338:Cladribine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004341:Drug Evaluation; D019008:Drug Resistance, Neoplasm; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D017338:Cladribine; D014740:Vidarabine; C024352:fludarabine
keywords: Acute myeloid leukaemia; Cladribine; Fludarabine; Refractory; Relapsed