According to an article recently published in the journal Cancer, high doses of cytosine arabinoside (Cytosar-U®) during initial treatment of acute myeloid leukemia among patients who are 60 years old or younger appears to improve outcomes, including survival, compared to lower doses of the agent. However, further study is necessary to determine the optimal timing for high-dose cytosine arabinoside.

Acute myeloid leukemia (AML) is a cancer of the bone marrow and blood characterized by the rapid, uncontrolled growth of immature white blood cells known as myelocytes. The disease is more common in adults than in children; average age at diagnosis is older than 65 years.

Treatment of AML often begins with induction therapy where chemotherapy is used to produce a complete remission (the disappearance of leukemia cells in the bone marrow and normalization of the white blood cell, red blood cell, and platelet levels). After induction therapy, patients generally receive additional treatment (consolidation therapy) to reduce the likelihood of a leukemia recurrence.

Researchers from Germany recently evaluated data from three clinical trials that compared the use of high-dose cytosine arabinoside to standard doses of cytosine arabinoside as induction therapy in patients with AML.

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  • Rates of complete disappearances of cancer were not significantly different between patients treated with standard or high doses of cytosine arabinoside.
  • Recurrence-free survival was significantly improved with treatment including high-dose cytosine arabinoside.
  • At four years, recurrence-free survival was significantly improved with treatment including high-dose cytosine arabinoside.
  • At four years, overall survival was significantly improved with treatment including high-dose cytosine arabinoside.

The researchers concluded that treatment including high-dose cytosine arabinoside as induction appears to significantly improve recurrence-free and overall survival compared to standard doses among patients younger than 60 years of age with AML. Patients with AML may wish to speak with their physician regarding their individual risks and benefits of treatment with high doses of arabinoside.

Reference: Kern W, Estey E. High-Dose Cytosine Arabinoside in the Treatment of Acute Myeloid Leukemia. Cancer. 2006; 107: 116 – 124.

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