Retrospective analysis of three induction chemotherapy regimens in acute myeloid leukemia including CPX-351, cytarabine/daunorubicin with and without the addition of cladribine

Abstract

Recently new treatments for acute myeloid leukemia (AML) emerged, including regimens like CPX-351 and cladribine with cytarabine and daunorubicin (DA + C), demonstrating improved survival in patient subsets. This retrospective analysis is comparing the outcome of 124 patients treated with cytarabine and daunorubicin (DA; n = 54), CPX-351 (n = 26) and DA + C (n = 44). Complete response rate following one cycle of therapy was increased in DA + C (62%) compared to CPX-351 (42%) and DA (50%). CPX-351 demonstrated a significant increased survival post allogenic stem cell transplantation against DA (hazard ratio (HR): 4.9; 95% confidence interval (95%CI): 1.1–21, p = 0.03). Median survival was reached for DA (5.6 years) but not for DA + C or CPX-351. Subgroup analysis showed that AML with myelodysplasia-related changes and therapy-related AML treated with CPX-351 had increased survival compared to DA (HR: 5.2; 95%CI: 1.2–22; p = 0.03). Our findings point twoards a CPX-351 superiority. However, the use of DA + C should be further evaluated in comparative studies.

Keywords:

• Acute myeloid leukemia
• induction therapy
• cladribine
• vyxeos
• cpx-351

Author contributions

FK, PK: designed the study, collected clinical data, performed the analysis and preparation of the manuscript; WF: designed the study and preparation the manuscript; WHA, SG, FM, CB collected clinical data and proof reading of the manuscript; CW, FB, CB: interpretation of the data and preparation of the manuscript. All authors approved the final manuscript.

Disclosure statement

FK: support for meeting attendance from Servier, Gilead, Jazz Pharmaceuticals, Novartis, Amgen, WHA: none, SG: none, CW: none, FB: none, CB: personal fees from Sanofi Aventis, personal fees from Merck KgA, personal fees from Bristol-Myers Squibb, personal fees from Merck Sharp & Dohme, personal fees from Lilly Imclone, personal fees from Bayer Healthcare, personal fees from GSO Contract Research, personal fees from AOK Rheinland-Hamburg, personal fees from Novartis, outside the submitted work, WF: advisory board: Amgen, ARIAD/Incyte, Pfizer, Novartis, Celgene, Jazz Pharmaceuricals, Abbvie; reports patents/royalties: Amgen. Reports non-financial support: Amgen, Gilead, GSO, Teva, Jazz Pharmaceuticals, Daiichi Sankyo, Servier; Research funding: Amgen, FM: support for meeting attendance from Servier, Abbvie, Incyte, Gilead, Jazz Pharmaceuticals, Novartis, Teva, Pfizer, Amgen, received support for medical writing from Servier, received research grant from Daiichi Sankyo and received speaker honorarium from Servier, Jazz Pharmaceuticals and Abbvie, PK: personal fees from Janssen-Cliag, outside the submitted work and stockholder: Abbvie.