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MYELOID LEUKEMIA : Original Article
doi:
10.4103/2278-330X.149918
Role of low dose cytarabine in elderly patients with acute myeloid leukemia: An experience
1
Departments of Clinical Haematology, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
2
Lab Haematology, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
3
General Surgery, Sher I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
*Corresponding author: Dr Yasir Bashir. yasir.bashir@rediffmail.com
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Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Purpose: To highlight the acceptable results seen after use of low dose cytarabine in elderly patients of acute myeloid leukemia (AML) with comorbidities. Materials and Methods: This was a prospective study carried on 30 newly diagnosed patients of AML over 60 years of age who were unfit for standard treatment regimens. We did not use azacytidine and decitabine in our patients because these therapeutic modalities being extremely costly and our patient affordability being poor. After taking patient consent and institutional ethical clearance these patients were treated with 20 mg/m2 cytarabine subcutaneously in two divided doses 12 h apart for 4 days every week for 4 weeks which constituted a cycle before disease, re-assessment was done. A repeat cycle was administered where ever needed and after attainment of remission, we continued low dose cytarabine for 2 days/week as maintenance after complete or partial response was documented. Results: In our study, we found that around 20% of patients achieved complete remission and 30% partial remission. The remission rates were definitely influenced by counts at presentation, performance at presentation, comorbidities, underlying myelodysplastic syndrome and baseline cytogenetics. Conclusion: Low dose cytarabine is effective treatment option for elderly patients with AML when standard treatment options are not warranted.
Keywords
References
- Sneader W. Drug Discovery : A 0 History. New York: Wiley; 2005,p. 258.
- Holowiecki J, Grosicki S, Robak T, Kyrcz-Krzemien S, Giebel S, Hellmann A, et al. Addition of cladribine to daunorubicin and cytarabine increases complete remission rate after a single course of induction treatment in acute myeloid leukemia. Multicenter, phase III study. Leukemia 2004;18:989-97
- Yates JW, Wallace HJ Jr, Ellison RR, Holland JF. Cytosine arabinoside (NSC-63878) and daunorubicin (NSC-83142) therapy in acute nonlymphocytic leukemia. Cancer Chemother Rep 1973;57:485-8.
- Mehta J, Powles R, Treleaven J, Horton C, Tait D, Meller S, et al. Long-term follow-up of patients undergoing allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission after cyclophosphamide-total body irradiation and cyclosporine. Bone Marrow Transplant 1996;18:741-6.
- Fernandez HF, Sun Z, Yao X, Litzow MR, Luger SM, Paietta EM, et al. Anthracycline dose intensification in acute myeloid leukemia. N Engl J Med 2009;361:1249-59
- Wedding U, Röhrig B, Klippstein A, Fricke HJ, Sayer HG, Höffken K. Impairment in functional status and survival in patients with acute myeloid leukaemia. J Cancer Res Clin Oncol 2006;132:665-71.
- Greenwood MJ, Seftel MD, Richardson C, Barbaric D, Barnett MJ, Bruyere H, et al. Leukocyte count as a predictor of death during remission induction in acute myeloid leukemia. Leuk Lymphoma 2006;47:1245-52.
- Castaigne S, Tilly H, Sigaux F, Daniel MT, Degos L. Treatment of leukemia with low dose Ara-C : a0 study of 159 cases. Haematol Blood Transfus 1985;29:56-9.
- Lotem J, Sachs L. Different blocks in the differentiation of myeloid leukemic cells. Proc Natl Acad Sci U S A 1974;71:3507-11
- Bianchi Scarrà GL, Romani M, Coviello DA, Garrè C, Ravazzolo R, Vidali G, et al. Terminal erythroid differentiation in the K-562 cell line by 1-beta-D-arabinofuranosylcytosine : a0 ccompaniment by c-myc messenger RNA decrease. Cancer Res 1986;46:6327-32
- Juliusson G, Höglund M, Karlsson K, Löfgren C, Möllgård L, Paul C, et al. Increased remissions from one course for intermediate-dose cytosine arabinoside and idarubicin in elderly acute myeloid leukaemia when combined with cladribine. A randomized population-based phase II study. Br J Haematol 2003;123:810-8.
- Juliusson G, Antunovic P, Derolf A, Lehmann S, Möllgård L, Stockelberg D, et al. Age and acute myeloid leukemia : r0 eal world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood 2009;113:4179-87.
- Al-Ali HK, Jaekel N, Niederwieser D. The role of hypomethylating agents in the treatment of elderly patients with AML. J Geriatr Oncol 2014;5:89-105.
- Willemze R, Suciu S, Meloni G, Labar B, Marie JP, Halkes CJ, et al. High-dose cytarabine in induction treatment improves the outcome of adult patients younger than age 46 years with acute myeloid leukemia : r0 esults of the EORTC-GIMEMA AML-12 trial. J Clin Oncol 2014;32:219-28.
- Sekeres MA, Elson P, Kalaycio ME, Advani AS, Copelan EA, Faderl S, et al. Time from diagnosis to treatment initiation predicts survival in younger, but not older, acute myeloid leukemia patients. Blood 2009;113:28-36
- Cheson BD, Bennett JM, Kopecky KJ, Büchner T, Willman CL, Estey EH, et al. Revised recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. J Clin Oncol 2003;21:4642-9.
- Baccarani M, Tura S. Differentiation of myeloid leukaemic cells : n0 ew possibilities for therapy. Br J Haematol 1979;42:485-7.
- Moloney WC,Rosenthal DS. Treatment of early acute nonlymphoblastic leukemia with low-dose cytosine arabinoside. In: Neth R, Gallo RC, Graf T, Mannweiler K, Winker K, editors. Modern Trends in Human Leukemia Cells IV. Berlin,Heidelberg, New York:Springer; 1981. p. 59-62
- Housset M, Daniel MT, Degos L. Small doses of ARA-C in the treatment of acute myeloid leukaemia : d0 ifferentiation of myeloid leukaemia cells? Br J Haematol 1982;51:125-9.
- Robles C, Kim KM, Oken MM, Bennett JM, Letendre L, Wiernik PH, et al. Low-dose cytarabine maintenance therapy vs observation after remission induction in advanced acute myeloid leukemia: An Eastern Cooperative Oncology Group Trial (E5483). Leukemia 2000;14:1349-53.
- H. J. Weh, R. Zschaber, A. von Paleske, and D. K. Hossfeld. Treatment of Acute Myeloid Leukemia and MyelodysplasticSyndrome by Low Dose Cytosine Arabinoside Haematology and Blood Transfusion Vol. 29. 1985.
- Burnett AK, Milligan D, Prentice AG, Goldstone AH, McMullin MF, Hills RK, et al. A comparison of low-dose cytarabine and hydroxyurea with or without all-trans retinoic acid for acute myeloid leukemia and high-risk myelodysplastic syndrome in patients not considered fit for intensive treatment. Cancer 2007;109:1114-24.
- Nelson R. Lower cytarabine doses effective and less toxic in AML patients. N Engl J Med 2011;364:1027-36.