Salvage chemotherapy options for relapsed/refractory acute myeloid leukemia

This study aimed to compare two salvage chemotherapy regimens for relapsed/refractory acute myeloid leukemia. This study concluded that there were no significant differences between the two regimens apart from cost. 

Salvage chemotherapy is used to treat cancers that do not respond to other treatments. Relapsed or refractory acute myeloid leukemia (rrAML) can be treated using salvage chemotherapy. Clofarabine-based salvage chemotherapy is one treatment that can be used. This regimen uses granulocyte colony stimulating factor, clofarabine and high-dose cytarabine (GCLAC). Cladribine-based salvage chemotherapy can also be used to treat rrAML. This regimen uses cladribine, cytarabine and granulocyte colony stimulating factor (CLAG).

There is a lack of information comparing GCLAC and CLAG regimens. It was not known if one of these regimens had an advantage over the other. 

This study involved 41 patients who had rrAML. 22 were treated with GCLAC and 19 were treated with CLAG. The treatments were compared by measuring complete remission (CR, no sign of active disease) rate. Other outcomes were the number of patients who underwent stem cell transplant (HSCT), the rate of relapse free survival (RFS, time from treatment until disease relapse) and the rate of overall survival (OS, time from treatment until death from any cause).

64% of GCLAC patients had CR compared to 47% of CLAG patients. 45% of GCLAC patients underwent HSCT compared to 26% of CLAG patients. The average RFS was 1.59 years for the GCLAC patients compared to 1.03 years for the CLAG patients. The average OS for the GCLAC patients was 1.03 years compared to 0.70 years for the CLAG patients.

The cost of a treatment cycle of GCLAC was on average $60,821.60 compared to an average of $4910.60 for a treatment cycle of CLAG.

This study concluded that there were no significant differences in outcomes for rrAML patients treated with GCLAC and CLAG. However, GCLAC treatment costs significantly more than CLAG treatment. 

Further studies need to be carried out. This study was conducted in the United States (North Carolina). The cost of treatment will differ in other areas and countries.

Consult your physician about suitable salvage chemotherapy options.