Récher Christian, Dumas Pierre-Yves, Bérard Emilie, Tavitian Suzanne, Leguay Thibaut, Galtier Jean, Alric Camille, Bidet Audrey, Delabesse Eric, Rieu Jean Baptiste, Vial Jean-Philippe, Vergez François, Luquet Isabelle, Klein Emilie, de Grande Anne-Charlotte, Sarry Audrey, Zukunft Sven, Platzbecker Uwe, Müller-Tidow Carsten, Baldus Claudia D, Bornhäuser Martin, Serve Hubert, Bertoli Sarah, Pigneux Arnaud, Röllig Christoph
Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France.
Institut National de la Santé et de la Recherche Médicale, U1312, Service d'Hématologie Clinique et de Thérapie Cellulaire, Université de Bordeaux, CHU Bordeaux, Bordeaux, France.
Am J Hematol. 2025 Jan;100(1):23-32. doi: 10.1002/ajh.27510. Epub 2024 Nov 18.
According to current recommendations, older AML patients in first complete remission (CR) after induction chemotherapy should receive consolidation with intermediate-dose cytarabine (IDAC). However, no study has demonstrated the superiority of IDAC over other regimen. In this retrospective study, we compared the efficacy of mini-consolidations (idarubicin 8 mg/m day 1, cytarabine 50 mg/m/12 h, day 1-5) and IDAC. Inclusion criteria were newly diagnosed AML, age > 60 years, first CR after induction and at least 1 cycle of consolidation. Of the 796 included patients, 322 patients received mini-consolidations and 474 patients received IDAC. Mini-consolidation patients were older, and more often, they had de novo AML and unfavorable risk. The rate of allogeneic transplantation was higher in the IDAC group. The median number of cycles was higher in the mini-consolidation group (4 vs. 2; p < .0001). Median relapse-free survival was 18 months with mini-consolidations and 12 months with IDAC (p = .0064). In multivariate analysis, the risk of relapse or death was significantly higher in the IDAC group (p = .004). Median OS was 36 versus 31 months with mini-consolidations or IDAC, respectively (p = .46). In multivariate analysis, the consolidation regimen had no significant influence on OS (p = .43). In older AML patients, post-remission therapy with mini-consolidations represents an alternative to IDAC.
根据目前的建议，诱导化疗后首次完全缓解（CR）的老年急性髓系白血病（AML）患者应接受中剂量阿糖胞苷（IDAC）巩固治疗。然而，尚无研究证明IDAC优于其他方案。在这项回顾性研究中，我们比较了小剂量巩固治疗（去甲氧柔红霉素8mg/m²第1天，阿糖胞苷50mg/m²每12小时1次，第1 - 5天）和IDAC的疗效。纳入标准为新诊断的AML、年龄>60岁、诱导治疗后首次CR且至少接受1个周期的巩固治疗。在796例纳入患者中，322例患者接受小剂量巩固治疗，474例患者接受IDAC治疗。接受小剂量巩固治疗的患者年龄更大，且更常为初发AML和预后不良风险患者。IDAC组的异基因移植率更高。小剂量巩固治疗组的中位周期数更高（4比2；p<0.0001）。小剂量巩固治疗组的中位无复发生存期为18个月，IDAC组为12个月（p = 0.0064）。在多变量分析中，IDAC组的复发或死亡风险显著更高（p = 0.004）。小剂量巩固治疗和IDAC组的中位总生存期分别为36个月和31个月（p = 0.46）。在多变量分析中，巩固治疗方案对总生存期无显著影响（p = 0.43）。对于老年AML患者，小剂量巩固治疗的缓解后治疗是IDAC的一种替代方案。
