Comparison of High-Dose Cytarabine, Mitoxantrone, and Pegaspargase (HAM-pegA) to High-Dose Cytarabine, Mitoxantrone, Cladribine, and Filgrastim (CLAG-M) as First-Line Salvage Cytotoxic Chemotherapy for Relapsed/Refractory Acute Myeloid Leukemia

Ciera L Patzke; Alison P Duffy; Vu H Duong; Firas El Chaer; James A Trovato; Maria R Baer; Søren M Bentzen; Ashkan Emadi

doi:10.3390/jcm9020536

Comparison of High-Dose Cytarabine, Mitoxantrone, and Pegaspargase (HAM-pegA) to High-Dose Cytarabine, Mitoxantrone, Cladribine, and Filgrastim (CLAG-M) as First-Line Salvage Cytotoxic Chemotherapy for Relapsed/Refractory Acute Myeloid Leukemia

J Clin Med. 2020 Feb 16;9(2):536. doi: 10.3390/jcm9020536.

Authors

Ciera L Patzke¹, Alison P Duffy^{1

2}, Vu H Duong^{1

3}, Firas El Chaer⁴, James A Trovato², Maria R Baer^{1

3}, Søren M Bentzen^{1

3}, Ashkan Emadi^{1

3}

Affiliations

¹ Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD 21201, USA.
² School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA.
³ School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
⁴ School of Medicine, University of Virginia, Charlottesville, VA 22908, USA.

Abstract

Currently, no standard of care exists for the treatment of relapsed or refractory acute myeloid leukemia (AML). We present our institutional experience with using either CLAG-M or HAM-pegA, a novel regimen that includes pegaspargase. This is a retrospective comparison of 34 patients receiving CLAG-M and 10 receiving HAM-pegA as first salvage cytotoxic chemotherapy in the relapsed or refractory setting. Composite complete response rates were 47.1% for CLAG-M and 90% for HAM-pegA (p = 0.027). Event-free survival was significantly different in favor of HAM-pegA (p = 0.045), though overall survival was similar between groups. There were no significant differences in toxicities experienced by patients treated with the two regimens, including adverse events of special interest related to pegaspargase (venous thromboembolism, hemorrhage, hepatotoxicity, pancreatitis, and hypersensitivity reactions). HAM-pegA is a novel regimen for relapsed or refractory AML that resulted in improved response rates and similar toxicities compared to CLAG-M.

Keywords: CLAG-M; HAM-pegA; acute myeloid leukemia; asparaginase; refractory; relapsed.

Grants and funding

P30CA134274/CA/NCI NIH HHS/United States