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High-dose cytarabine in acute myeloid leukemia treatment: a systematic review and meta-analysis.


ABSTRACT: The optimal dose, scheme, and clinical setting for Ara-C in acute myeloid leukemia (AML) treatment remain uncertain. In this study, we performed a meta-analysis to systematically assess the impact of high-dose cytarabine (HDAC) on AML therapy during the induction and consolidation stages. Twenty-two trials with a total of 5,945 de novo AML patients were included in the meta-analysis. Only patients less than 60 year-old were included in the study. Using HDAC in induction therapy was beneficial for RFS (HR?=?0.57; 95% CI, 0.35-0.93; P?=?0.02) but not so for CR rate (HR?=?1.01; 95% CI, 0.93-1.09; P?=?0.88) and OS (HR?=?0.83; 95% CI, 0.66-1.03; P?=?0.1). In consolidation therapy, HDAC showed significant RFS benefits (HR?=?0.67; 95% CI, 0.49-0.9; P?=?0.008) especially for the favorable-risk group (HR?=?0.38; 95% CI, 0.21-0.69; P?=?0.001) compared with SDAC (standard dose cytarabine), although no OS advantage was observed (HR?=?0.84; 95% CI, 0.55-1.27; P?=?0.41). HDAC treatment seemed less effective than auto-BMT/allo-BMT treatment (HR?=?1.66, 95% CI, 1.3-2.14; P<0.0001) with similar OS. HDAC treatment led to lower relapse rate in induction and consolidation therapy than SDAC treatment, especially for the favorable-risk group. Auto-BMT/allo-BMT was more beneficial in prolonging RFS than HDAC.

SUBMITTER: Li W 

PROVIDER: S-EPMC4192550 | BioStudies | 2014-01-01

REPOSITORIES: biostudies

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