WEDNESDAY, March 16 (HealthDay News) -- A lower dose of the drug
cytarabine work as well as the high doses that are typically used
to treat acute myeloid leukemia, and with fewer side effects, a new
Dutch study finds.
Cytarabine is used in the treatment of acute myeloid leukemia
(AML), along with other chemotherapy drugs and stem cell
transplantation. Cytarabine resembles a normal cell nutrient needed
by cancer cells to grow. However, when these cells take up
cytarabine, the drug actually interferes with their growth.
"The high-dose cytarabine schedules represent an unnecessary overdose causing excess toxicity with no apparent clinical benefit," said lead researcher Dr. Bob Lowenberg, a professor of hematology at Erasmus University Medical Center in Rotterdam. "The lower dose level is sufficient."
The report is published in the March 17 issue of the
New England Journal of Medicine.
For the study, Lowenberg's team compared two different
intravenous doses of cytarabine in patients with AML. One group of
431 patients was given a lower dose of the drug, while 429 were
given a high dose, which is the current standard dose.
Patients who had a complete response to the drug after the first
two cycles were taken off the drug, and treatment continued with
another type of chemotherapy or a stem cell implant.
Over five years of follow-up, the researchers found no
difference between the two groups in terms of remission. Eighty
percent of those who received the lower dose had a complete
remission, as did 82 percent of those who were given the higher
There was also no significant difference in probability of
relapse (34 percent of those given the lower dose and 35 percent of
those who received the higher dose), or in overall survival (40
percent in the lower-dose group and 42 percent in the high-dose
Not only that, but patients receiving the high doses were more
likely to suffer side effects than those given the lower doses, the
researchers added. These included skin reactions and
gastrointestinal and ocular toxic effects. Also, those given the
high dose had longer hospital stays and delays in the recovery of
white blood cells and platelets.
"The current standard of treatment with high-dose cytarabine, one of the major chemotherapeutic agents applied in the treatment of acute myeloid leukemia, represents an overdose," Lowenberg said.
One-tenth of the standard dose produces equally effective
treatment, but with less toxicity, shorter hospital stays and fewer
transfusions, he added.
"The lower-dose level also involves reduced costs," Lowenberg said. "These results set a new standard of care for the therapy of acute myeloid leukemia."
Dr. Mark H. Kirschbaum, an associate member for malignant
hematology at the Nevada Cancer Institute in Las Vegas, said that
"this is a very important study that will likely impact upon the
treatment of patients with acute myeloid leukemia, particularly the
older patient population, who clinically have always seemed to
suffer from significant toxicity with higher-dose regimens."
"Hopefully progress in the molecular therapeutics of leukemia will allow us to more safely treat patients, particularly the older patients who make up the large majority of new AML patients, in a less toxic manner," he said.
For more information on acute myeloid leukemia, visit the
Leukemia & Lymphoma Society.
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