Comparing salvage treatments for relapsed/refractory acute myeloid leukemia

This study aimed to compare outcomes of salvage chemotherapy for patients with relapsed or refractory acute myeloid leukemia. 

This study concluded that the CLAG-M regimen (cladribine, cytarabine, filgrastim, and mitoxantrone) followed by transplant is a suitable salvage treatment for these patients.  

Salvage treatment is given after cancer does not respond to standard therapy. It used for patients with relapsed/refractory (R/R) cancer.  

There are three commonly used salvage treatments used for acute myeloid leukemia (AML). CLAG-M uses cladribine (Leustatin), cytarabine (Cytosar-U), filgrastim (Neupogen), and mitoxantrone (Novantrone). CLAG uses the same drugs without mitoxantrone. MEC uses mitoxantrone, etoposide (Etopophos), and cytarabine.  

It was unknown which salvage treatment option was most effective for R/R AML. 

This study involved 146 patients with R/R AML. 57.5% of patients had relapsed AML and 42.5% had refractory AML. 51% of patients were treated with CLAG-M as a salvage treatment. 39% of patients were treated with MEC. 10% of patients were treated with CLAG. Minimal residual disease (MRD) was measured. MRD is the small number of cancer cells that remain after treatment. MRD-positive status increases the risk of relapse. The average follow-up was 9 months.

The complete remission (CR) rate for the CLAG-M group was 54% compared to 40% for the MEC and CLAG groups. Of those who achieved CR, the MRD-negative CR rate was 39% for the CLAG-M group compared to 22% for the MEC/CLAG group.  

The average overall survival (OS) was 13.3 months for the CLAG-M group compared to 6.9 months for the MEC group and 6.2 months for the CLAG group.  

OS was significantly longer in patients who were MRD-negative (by 88%). Also, patients who had a stem cell transplant after salvage treatment had a 72% higher chance of longer OS.

This study concluded that CLAG-M treatment is a suitable salvage regime for patients with R/R AML. 

This study was based on medical records. Information regarding the safety of these regimens was not included.