ArticleAnnals of hematology2026
Intermediate doses cytarabine after induction with CPX-351 for patients with secondary AML: safety and efficacy.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Acute myeloid leukemia (AML), especially therapy-related (t-AML) or secondary AML (s-AML), presents complex therapeutic challenges. CPX-351, a liposomal formulation of cytarabine and daunorubicin, has demonstrated superior outcomes compared to standard 7 + 3 chemotherapy. However, optimal post-remission strategies are debated. This retrospective study evaluates the feasibility and efficacy of intermediate-dose ARA-C (IDAC), total dose of 8–9 g/m², following CPX-351 in 47 patients from three Italian centers. Median patient age was 69, with 64% having AML with myelodysplasia-related changes (MRC-AML). Based on the 2017 European LeukemiaNet (ELN) risk stratification, 8 patients were classified as favorable, 20 as intermediate, and 19 as adverse. The median overall survival (OS) was 21 months (IC95% 17–43), with 85% alive at 12 months and 48.4% at 24 months. Event-free survival (EFS) was 14.9 months (IC95% 11.7–28.2). Multivariate analyses identified adverse-risk ELN-2017 and MRD-positivity after CPX-351 as negative predictors for OS. IDAC was well tolerated, with manageable toxicities: neutropenic fever (27, grade 1–3) and mucositis (4, grade 2–3). Importantly, 70% of patients achieved stable or improved measurable residual disease (MRD) after consolidation. The study underscores IDAC as a viable consolidation strategy, especially for patients unable to receive further CPX-351 or awaiting transplant. Despite its retrospective nature and limited sample size, the findings suggest that IDAC may offer improved outcomes, including lower costs, compared to CPX-351.
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