Outpatient consolidation chemotherapy with intermediate dose cytarabine has similar survival and relapses rates in acute myeloid leukemia as compared to high dose cytarabine: A single center analysis

Abstract

IntroductionThe last decade has seen advances in delivering outpatient consolidation therapy for acute myeloid leukemia (AML). The standard of care involves high‐dose cytarabine or intermediate‐dose cytarabine, given twice daily for three alternating days. At the London Regional Cancer Program, we have transitioned the administration of outpatient cytarabine to a once‐daily regimen over six consecutive days. The outcomes of a longer duration interval of high‐dose cytarabine and intermediate‐dose cytarabine is currently unknown. This study aims to assess the feasibility of administering a continuous 6‐day protocol of high‐dose (HDAC‐16) and intermediate‐dose cytarabine (IDAC‐16) consolidation therapy in the outpatient setting.MethodsThis is a retrospective chart review to analyze AML patients treated with outpatient high‐dose or intermediate‐dose cytarabine consolidation therapy at the London Regional Cancer Program from January 1, 2019, through November 1, 2022. The primary objective was to determine the outcomes of the 6‐day outpatient administration of once daily high‐dose cytarabine or intermediate‐dose cytarabine.ResultsForty‐five patients received 89 cycles of cytarabine as outpatients; males were 55.6% of the total population, with a median age of ~57 years. Our overall 2‐year survival of HDAC‐16 (57.1%) and IDAC‐16 (83.3%) is consistent with the reported literature. There was no difference in delays, relapse rates, and nonrelapse mortality between both HDAC and IDAC groups. The 2‐year relapse free survival was 57.1% for HDAC‐16 and 66.7% for IDAC‐16.ConclusionOutpatient administration of intermediate‐dose cytarabine once daily over six consecutive days results in similar overall survival and relapse rates as compared to high dose cytarabine consolidation chemotherapy. Moving to a once daily administration schedule can alleviate logistical and/or accessibility hurdles for outpatient oncology clinics. Prospective randomized trials are needed in this setting to validate our results.