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High dose (18 g/m<sup>2</sup>) versus low dose (12 g/m<sup>2</sup>) cytosine arabinoside as consolidation for acute myeloid leukemia: A phase 3 study: An interim analysis

Date

21 Dec 2015

Session

Haematological malignancies

Presenters

Prashant Mehta

Citation

Annals of Oncology (2015) 26 (suppl_9): 85-92. 10.1093/annonc/mdv526

Authors

P. Mehta1, L. Kumar1, V. Raina1, A. Sharma1, S. Bakhshi1, A. Gogia1, R.K. Sahoo1, S. Pabbi2, A. Chopra3, R. Kumar3

Author affiliations

  • 1 Dept. Of Medical Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
  • 2 Dept. Of Pathology, Sardar Patel Medical College and associated Prince Bijaysingh Memorial Hospital, 34003 - Bikaner/IN
  • 3 Dept. Of Lab Oncology, All India Institute of Medical Sciences, 110029 - New Delhi/IN
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Abstract 1048

Aim/Background

In this phase 3, non-inferiority study patients were randomized to receive 3 cycles of HD Ara-C using either 18 g/m2 (arm A) or 12 g/m2 (arm B), 3 cycles each for consolidation.

Methods

Between August 2012 and May 2015, 170 patients of AML, in morphological CR following induction (3 + 7) have been recruited. Relapse-free survival (RFS) was the primary end point. Overall survival (OS), hematological/non-hematological toxicity, antimicrobial/GCSF requirement, transfusions and hospital stay were secondary end points. For a pre-planned interim analysis, 90 patients randomized till February 28, 2014, have been analyzed; with 45 patients in each arm. Median age was 12.5 years (range, 1 to 64). Cytogenetically, 35 (39%) of patients were in favorable risk, intermediate -38 (42%) and poor risk-9(10%) category. Patients' characteristics were similar in both arms. Analysis has been done intention to treat. Data has been censored till July 31, 2014.

Results

79/90 patients completed the treatment protocol; Arm A = 40, Arm B = 39, p = 0.74. Median duration of consolidation was 77.5 days, (range 58-148 days) and was similar in the two study arms (p = 0.16). There was no difference as regards the infectious/non-infectious toxicity, neutropenic fever (p = 0.45), antibiotic use (first/second/third line, p = 0.50), therapeutic anti-fungal use or blood/platelet transfusions (p = 0.43/0.75). Total hospitalization was not significantly different, but the high dose arm (arm A) required significantly more short admissions (daycare facility, <24 hours) for supportive care (12.2 days vs 10.34 days, p = 0.043) and received G-CSF for a longer period; 8.58 days vs 6.4 days, p = 0.042. 48 patients relapsed at a median of 12 months, relapse rate was similar in both arms; 25 (55%) in high dose arm vs. 23(51%) in lower dose arm, p= 0.67. Kaplan-Meier curves truncated at 12 months of follow-up showed an estimated OS of 89% (95% CI 0.73-0.95) in the 18 g/m2 (arm A) vs. 61% (95% CI 0.42-0.75) in the 12 g/m2 (arm B), p < 0.0023. Similarly, RFS was 58.6%( 95% CI 0.41-0.72) in arm A and 41.9%( 95% CI 0.25-0.57) in arm B,p < 0.036.

Conclusions

At interim analysis, consolidation therapy using 18 g/m2 Ara-C appears to confer better relapse-free and overall survival.

Clinical trial identification

NCT01615757

Disclosure

All authors have declared no conflicts of interest.

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