Dose-enhanced combined priming regimens for refractory acute myeloid leukemia and middle-and-high-risk myelodysplastic syndrome: a single-center, retrospective cohort study
Authors Ma X, Wang J, Xu Y, Zhang W, Liu J, Cao X, He A, Wang F, Gu L, Lei B, Wang J
Received 15 September 2015
Accepted for publication 12 January 2016
Published 20 June 2016 Volume 2016:9 Pages 3661—3669
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Federico Perche
Peer reviewer comments 2
Editor who approved publication: Professor Daniele Santini
Xiaorong Ma, Jin Wang, Yan Xu, Wanggang Zhang, Jie Liu, Xingmei Cao, Aili He, Fangxia Wang, Liufang Gu, Bo Lei, Jianli Wang
Department of Hematology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
Objective: To assess chemotherapeutic regimens for refractory acute myeloid leukemia (AML) and middle-and-high-risk myelodysplastic syndrome (MDS).
Methods: Between 2004 and 2014, 44 patients with refractory AML and 36 patients with MDS were treated with new priming regimens (CHAG, CHTG, CHMG, or CTMG), and 77 patients with refractory AML and 52 patients with MDS were treated with conventional priming regimens (CHG or CAG). This was a single-center retrospective analysis of remission, adverse event, mortality, and survival. The capacity of clinical features (including the expression of co-stimulatory molecule B7.1 on tumor cells) to influence survival was assessed by multivariate Cox regression.
Results: Complete and partial remission rates (RRs) were significantly higher in AML patients treated with new regimens compared to conventional ones (68.2% vs 13.6%, P<0.05). Complete and partial remission were also significantly higher in patients with MDS treated with new regimens (55.6% vs 19.4%, P<0.05). However, although survival advantages were observed in the first year, the new regimens did not significantly improve 3-year overall survival (P>0.05). Patients administered the new regimens experienced more severe and sustained myelosuppression (P<0.05), but no severe adverse events or treatment-related deaths were observed. The rate of non-hematological side effects did not differ significantly between treatment regimens (P>0.05). Both RR and B7.1 expression were significantly higher in patients with AML-M2 and M5 (P<0.05).
Conclusion: The new priming regimens improved the RR, lowered the recurrence rate, and improved survival in AML and middle-and-high-risk MDS, without significantly increasing adverse events.
Keywords: priming chemotherapy, acute myeloid leukemia, myelodysplastic syndrome, B7.1
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