AML-154 Induction Mortality of Acute Myeloid Leukemia Patients Treated With Purine Analogues-Cytarabine-Anthracycline at General Hospital

Abstract

Despite the fact that purine analogs (fludarabine/cladribine) in combination with cytarabine and idarubicin (FIA/CLIA) have a higher CR rate than '3+7' (historically, 60%), cytarabine-anthracyclines (7+3) induction chemotherapy (IC) remains the standard acute myeloid leukemia (AML) IC. Cytarabine-anthracyclines (7+3) IC has been the mainstay therapy for over four decades, and it remains the standard AML IC regimen internationally. Triplet IC using FIA/CLIA is superior to the standard 7+3 regimen but is challenging to administer in general hospital settings due to myelosuppression. We reviewed the AML induction mortality (IM) rate in patients induced with (fludarabine/cladribine) combined with cytarabine and idarubicin (FIA/CLIA) at Memorial Hermann Hospital, Texas Medical Center. Of 44 AML patient records reviewed from January 2013 to January 2022, 40 received 5 days FIA/CLIA IC and four received 3-4 days due to age and comorbidities. Clinical characteristics analyzed included gender, race, ECOG PS, ELN risk stratification, molecular characteristics, and disease origin. The median age was 51.5 years (range: 18-68). Three patients died before assessment. The composite CR (CR+CRi) was 82.9% (34/41) after 1 cycle and 87.8% (36/41) after 2 cycles. MRD-negative composite CR was 92%. Four patients had adverse risk cytogenetics and primary induction failure (modified FIA). Thirty-seven percent had febrile neutropenia, 25% had bacteremia, 15% required ICU admission, and 4% required mechanical ventilation. The 30-day induction mortality was 9%. FIA/CLIA has a higher CR rate than '3+7' (historically, 60%). Given the fact that in AML, achieving CR is the most important factor to improve survival with adequate treatment expertise, a triplet IC regimen can be safely administered with low IM and superior results.