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Cytarabine, aclarubicin and granulocyte colony-stimulating factor regimen represents an effective and safe salvage regimen for patients with acute myeloid leukemia refractory to first course of induction chemotherapy

Abstract There is no consensus regarding the optimal second induction course regimen for patients with acute myeloid leukemia (AML) refractory to an initial course of front-line induction. The CAG regimen (cytarabine, aclarubicin and granulocyte colony-stimulating factor) has shown promise for relapsed/refractory AML. We retrospectively compared the efficacy and toxicity of the CAG regimen (n = 44) with a non-CAG regimen (n = 31) in 75 patients with AML refractory to an initial induction chemotherapy. The complete remission (CR) rate was higher for the CAG than the non-CAG regimen (63.5% vs. 38.7%, p = 0.038), and this was more pronounced in the subgroup of patients with a lower white blood cell (WBC) count before first/second induction, better- and intermediate-risk patients, and non-AML-M4/5 (p = 0.019). Although the CAG group demonstrated a higher disease-free survival than the non-CAG group among the intermediate- and poor-risk patients (p = 0.019), no differences in overall survival were observed. The CAG regimen produced hematological and non-hematological side effects similar to those of the non-CAG regimen. The most frequent CAG regimen side effects were infection (45.5%), fever (50%) and elevated transaminase levels (31.8%). No patients died within 4 weeks after initiating the second induction course in the CAG regimen. Thus, CAG represents a highly effective and safe salvage regimen for patients with AML who are refractory to the first induction chemotherapy. This regimen may be of specific benefit for CR in patients with low WBC count, better- and intermediate-risk, and non-M4/5 disease.