Cytarabine, aclarubicin and G-CSF as salvage treatment for hard to treat T cell acute lymphoblastic leukemia

This study aimed to investigate cytarabine (Cytosar-U), aclarubicin (Aclacin) and G-CSF (Neupogen) as a salvage treatment for adult patients with relapsed or refractory T cell acute lymphoblastic leukemia.  

This study concluded that this treatment combination is safe and effective as a salvage treatment in these patients. 

Patients with relapsed or refractory (R/R) T-cell acute lymphoblastic leukemia (T-ALL) often have a poor prognosis. Treatment failure often occurs. A salvage treatment is used when an initial treatment fails. Cytarabine, aclarubicin and G-CSF (CAG) is a salvage treatment that has shown promising results in patients with R/R T-ALL. 

Allogenic stem cell transplantation (allo-HSCT) is an option after treatment failure. This involves taking healthy stem cells from a donor and transplanting them into the patient. It aims to replace cells killed during chemotherapy and other treatments. 

It was unknown if CAG would be an optimal salvage treatment to provide a bridge to allo-HSCT in patients with R/R T-ALL. 

This study involved 41 patients with R/R T-ALL who received CAG as a salvage therapy. They were followed up for an average of 12 months. 

After one cycle of CAG, 80.5% of patients achieved complete remission (CR) and 4.9% achieved partial remission (PR). 14.6% patients did not respond to CAG treatment. Allo-HSCT was successfully performed in 66% of patients (22 patients with a CR and 5 patients with a PR).  

The estimated 2-year overall survival rate was 68.8%. The estimated 2-year event-free survival (patients alive without complications from ALL) rate was 56.5%.  

The CAG treatment was well-tolerated and no early death occurred. The most common side effects were low levels of white blood cells (73%) and low levels of platelets (blood cells involved in clotting; 78%). Infections were also common side effects (58%).  

This study concluded that the CAG regimen is safe and effective as a salvage treatment in adult patients with R/R T-ALL and provides a good bridge to transplantation. 

This study included a small number of patients and had a short follow-up period. Larger studies are needed to confirm these results.