Low-dose Cytarabine plus Aclarubicin for Patients with Previously Untreated Acute Myeloid Leukemia or High-risk Myelodysplastic Syndrome Ineligible for Standard-dose Cytarabine plus Anthracycline
Anticancer Research,

Fukushima T et al. – Caclarubicin (CA) combination with Granulocyte colony–stimulating factor (G–CSF) as remission–induction therapy is promising and well–tolerated in patients with previously untreated acute myeloid leukemia (AML) or high–risk myelodysplastic syndrome (MDS) who are ineligible for standard–dose Ara–C plus anthracycline without leukocytosis. In order to improve relapse–free survival (RFS), intensive postremission chemotherapy or allogeneic hematopoietic stem cell transplantation should be introduced.

• Data of twenty patients with untreated AML or high-risk MDS who were ineligible for standard-dose Ara-C plus anthracycline and received CA as remission-induction therapy were analyzed.
• CA consisted of low-dose Ara-C (10mg/m², subcutaneous injection every 12hours, for 14days) and aclarubicin (14mg/m² for patients <70years old and 10mg/m² for patients ≥70years old in a one-hour infusion for 4days).
• Granulocyte colony-stimulating factor (G-CSF) was used from day 1 of CA to white blood cell count (WBC) recovery, except for patients with initial WBC of more than 20.0×103/mm³.

• Eleven patients (55%) achieved complete remission.
• All four patients whose WBC were ≥20.0×103/mm³ and did not receive G-CSF were refractory to CA.
• The predicted 2-year overall survival rate and median survival duration of all 20 patients were 37.9% and 363 days, respectively.
• The predicted 1-year relapse-free survival (RFS) rate and median duration of RFS of 11 patients who achieved complete remission were 30.3% and 332days, respectively.
• Only one patient died due to transfusion-related acute lung injury.
• No patients died due to severe infections.