Clofarabine Plus Low-Dose Cytarabine Is as Effective as and Less Toxic Than Intensive Chemotherapy in Elderly AML Patients

Koichi Takahashi, Hagop Kantarjian, Guillermo Garcia-Manero, Gautam Borthakur, Tapan Kadia, Courtney Dinardo, Elias Jabbour, Sherry Pierce, Zeev Estrov, Marina Konopleva, Michael Andreeff, Farhad Ravandi, Jorge Cortes

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Introduction Most patients with acute myeloid leukemia (AML) age ≥ 60 years are not offered intensive induction because of high mortality. Phase 2 studies of clofarabine plus low-dose cytarabine (CLDA) as frontline therapy for elderly AML patients demonstrated high response and acceptable toxicity. Patients and Methods We hypothesized that induction therapy with CLDA provides equivalent outcomes to but is less toxic than intensive induction in these patients. To test this hypothesis, we conducted a propensity score-matched comparison of AML patients age ≥ 60 years given induction CLDA versus idarubicin and cytarabine (IA). Ninety-five patients in both groups were matched according to their propensity score. Results We did not observe statistically significant differences in response, overall survival, or mortality rate between the two induction regimens. However, CLDA produced significantly fewer grade 3 or worse toxicities (46% for CLDA vs. 62% for IA; P =.03). Furthermore, among responders, the median response duration was significantly longer with CLDA when we censored patients who underwent stem cell transplantation (15.9 months for CLDA vs. 7.0 months for IA; P =.033). Conclusion Compared with intensive induction, CLDA offers equivalent responses and survival but less toxicity in clinically well-matched cohorts of elderly AML patients. Prospective randomized trials to confirm these findings are warranted.

Original languageEnglish (US)
Pages (from-to)163-168.e2
JournalClinical Lymphoma, Myeloma and Leukemia
Volume16
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Keywords

  • Acute myeloid leukemia
  • Clofarabine
  • Induction therapy
  • Intensive chemotherapy
  • Propensity matching

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Takahashi, K., Kantarjian, H., Garcia-Manero, G., Borthakur, G., Kadia, T., Dinardo, C., Jabbour, E., Pierce, S., Estrov, Z., Konopleva, M., Andreeff, M., Ravandi, F., & Cortes, J. (2016). Clofarabine Plus Low-Dose Cytarabine Is as Effective as and Less Toxic Than Intensive Chemotherapy in Elderly AML Patients. Clinical Lymphoma, Myeloma and Leukemia, 16(3), 163-168.e2. https://doi.org/10.1016/j.clml.2015.11.016