Abstract
Introduction: For patients with high-risk acute myeloid leukemia (AML), defined by certain cytogenetic (CG) and molecular genetic features, hematopoietic stem cell transplantation (HSCT) remains the only curative therapy. The logistics of proceeding to transplant might necessitate consolidation chemotherapy involving high dose cytarabine (HiDAC).
Methods: We performed a retrospective cohort analysis and evaluated outcomes of high-risk AML patients treated at the Georgia Cancer Center at Augusta University, who were diagnosed and either did or did not receive HiDAC consolidation therapy between November 2003 and December 2020. For those not transplanted, we reviewed the clinical course following HiDAC consolidation therapy and identified the adverse effects, if any, that would preclude HSCT.
Results: A total of 92 high-risk AML patients were evaluated; 81.5% received induction therapy (mean age 50.8), while 18.5% did not (mean age 75.4, P<0.0001). Patients who received HiDAC had a 50% HSCT rate; infection-related complications were a major barrier. Patients who did not receive HiDAC following induction had a 45.9% HSCT rate; disease progression and performance status were the major barriers. Mean age differed significantly between non-HiDAC patients who did vs. did not receive HSCT (44.3 vs. 65.7, P=0.0002). Infections included Klebsiella, VRE, and fungal sinusitis. Median time to HSCT was 326.5 days with HiDAC vs. 127 days without.
Conclusion: Our findings suggest starting the HSCT evaluation process during the induction admission. HSCT is the sole curative option for high-risk AML patients and HiDAC consolidation may prevent a subset of these patients from receiving HSCT due to increased toxicity, immunosuppression, and infections.
Keywords
Acute myeloid leukemia, High-dose cytarabine, Intermediate-dose cytarabine, Hematopoietic stem cell transplantation, Myeloid leukemia, Leukemia