Низкодозовая химиотерапия оказалась не менее эффективной, но безопаснее стандартной при лечении детского острого миелоидного лейкоза

Among pediatric patients with acute myeloid leukemia (AML), a low-dose chemotherapy (LDC) induction regimen appears to be non-inferior to standard dosage, according to research published in Blood. The study authors noted that complete remission (CR), event-free survival, and overall survival (OS) rates were comparable between the 2 evaluated groups. Standard chemotherapy combinations are linked with a high rate of toxicity for pediatric patients with AML that can cause both acute and chronic complications as survivors grow and age. For this study, researchers evaluated whether an LDC induction regimen, which is commonly used in elderly patients, is non-inferior to standard-dose regimens among pediatric patients with AML. The LDC regimen consisted of low-dose cytarabine, mitoxantrone or idarubicin, and granulocyte colony–stimulating factor, while the standard-dose regimen consisted of cytarabine, daunomycin, and etoposide. Overall, 438 patients were randomly assigned to either the LDC arm (223 patients) or the standard dose arm (215 patients). 200 patients in each group completed the first round of induction therapy, while 19 and 21 patients, respectively, completed 2 full induction rounds and 4 full consolidation rounds. In the overall cohort, 53.5% of patients were between 3 and 10 years, 59% were male sex, and 58% had low- or intermediate-risk disease. Characteristics were balanced between the 2 treatment arms. The median follow-up period across the cohort was 28 months. Analysis showed that the CR/CR with incomplete count recovery rates were 95.1% in the LDC group vs 95.3% in the standard-dose group; the measurable residual disease rates of less than 0.1% were 87.4% and 87.1%, respectively. These findings support the LDC regimen as an effective and less toxic alternative for remission induction in pediatric AML. There was, moreover, no difference in the 4-year event-free survival rates (61.5% with LDC vs 63.1% with standard dosage; P =.832) or in the 4-year OS rates (81.3% vs 83.6%, respectively; P =.611). In the LDC group, the rates of grade 3 or worse thrombocytopenia (57.1% vs 76.7% in the standard-dosage arm; P <.001), anemia (36.9% vs 56.4%, respectively; P <.001), and febrile neutropenia (25.6% vs 50%; P <.001) were all lower than were rates in the standard-dose group. “The low-intensity approach resulted in fewer grade [3 or worse] nonhematologic toxicities, faster hematologic recovery, substantially reduced transfusion needs, and lower overall induction costs,” the authors wrote in their report. “These findings support the LDC regimen as an effective and less toxic alternative for remission induction in pediatric AML.” Disclosures: This research was supported by the National Key Research and Development Program of China. Please see the original reference for a full list of disclosures. This article originally appeared on Hematology Advisor