Comparison of Clinical Efficacy of Cytarabine with Different Regimens in Postremission Consolidation Therapy for Adult t(8;21) AML Patients: A Multicenter Retrospective Study in China

Efficacy and safety of consolidation therapy with intermediate and high dose cytarabine in acute myeloid leukemia patients

OBJECTIVES

The primary objective was to compare the efficacy of intermediate-dose cytarabine (IDAC) and high-dose cytarabine (HiDAC) as consolidation chemotherapy for acute myeloid leukemia (AML) in terms of a one-year-relapse-free survival rate (RFS). The secondary objectives were one-year-overall survival rate (OS) and adverse effects.

METHODS

This was a retrospective study conducted at Chiang Mai University Hospital. AML patients who achieved complete remission after 7 + 3 induction regimen and received consolidation therapy with either IDAC or HiDAC during January 2015 and January 2018 were eligible. Data about clinical characteristics, efficacy and safety of IDAC and HiDAC regimens were collected.

RESULTS

Sixty-two AML patients were enrolled (30 patients in IDAC and 32 patients in the HiDAC regimen). The one-year RFS in the IDAC group was 63.33% and 46.87% in the HiDAC group (P = 0.137). The 1-year OS was 93.33% and 84.37% in the IDAC and HiDAC, respectively (P = 0.691). The duration of grade 3-4 thrombocytopenia was significantly shorter in IDAC than HiDAC (mean duration 14.69 vs. 23.84 days; P = 0.045). There was no significant difference in other parameters including hemoglobin nadir, absolute neutrophil count nadir, platelet nadir, febrile neutropenia, duration of grade 3-4 neutropenia, and duration of hospitalization.

DISCUSSION AND CONCLUSIONS

There was no significant difference in the one-year RFS and OS between IDAC and HiDAC. The IDAC regimen is an acceptable option for consolidation treatment in AML.

Loss of X chromosome predicts favorable prognosis in female patients with t(8;21) acute myeloid leukemia

The prognostic significance of loss of X chromosome (-X) in t(8;21) acute myeloid leukemia (AML) remains unclear. We evaluated the role of -X in 158 female patients with t(8;21) AML collected retrospectively from 15 Chinese AML study groups. Patients with -X accounted for 25.3% and showed a significantly higher complete remission rate, better 3-year cumulative incidence of relapse (25.2 vs. 50.5%, p = 0.013), relapse-free survival (69.4 vs. 44.7%, p = 0.025), and overall survival (77.4 vs. 52.7%, p = 0.026) compared with those without -X. Patients with -X were more likely to achieve minimal residual disease negativity (risk ratio = 1.62; p = 0.020). A Multivariate analysis adjusting for age, white blood cell, KIT-D816 mutation, high-dose cytarabine consolidation therapy, and allogeneic hematopoietic stem-cell transplantation showed -X to be an independent favorable prognostic factor. Our results suggest that -X may be associated with better outcomes in patients with t(8;21) AML.

Loss of the Y chromosome predicts a high relapse risk in younger adult male patients with t(8;21) acute myeloid leukemia on high-dose cytarabine consolidation therapy: a retrospective multicenter study

The prognostic significance of loss of the Y chromosome (LOY) in patients with t(8;21)(q22;q22) acute myeloid leukemia (AML) remains poorly understood. To investigate this issue, 226 younger adult male patients with t(8;21) AML from 15 Chinese hematology research centers were retrospectively evaluated, among which, 50.4% had LOY. In patients receiving high-dose cytarabine (HiDAC) consolidation therapy, LOY was associated with a significantly higher cumulative incidence of relapse (CIR, HR = 2.18, p = .048), worse relapse-free survival (RFS, HR = 2.39, p = .026), and worse but not significant overall survival (OS, HR = 2.71, p = .166). A multivariate analysis adjusted for age, WBC, KIT mutations, and minimal residual disease showed LOY to be an independent adverse prognostic factor for relapse in patients on HiDAC consolidation therapy. Our results suggest that LOY may be associated with a high relapse risk in t(8;21) AML patients receiving HiDAC therapy during consolidation.

Angiomodulators in cancer therapy: New perspectives

The formation of new blood vessels plays a crucial for the development and progression of pathophysiological changes associated with a variety of disorders, including carcinogenesis. Angiogenesis inhibitors (anti-angiogenics) are an important part of treatment for some types of cancer. Some natural products isolated from marine invertebrates have revealed antiangiogenic activities, which are diverse in structure and mechanisms of action. Many preclinical studies have generated new models for further modification and optimization of anti-angiogenic substances, and new information for mechanistic studies and new anti-cancer drug candidates for clinical practice. Moreover, in the last decade it has become apparent that galectins are important regulators of tumor angiogenesis, as well as microRNA. MicroRNAs have been validated to modulate endothelial cell migration or endothelial tube organization. In the present review we summarize the current knowledge regarding the role of marine-derived natural products, galectins and microRNAs in tumor angiogenesis.