Impact of high dose cytarabine dosing strategies in obese patients with acute myeloid leukemia. (March 2021)

• Record Type: Journal Article
• Authors: Ochs, Madeleine A.; Perissinotti, Anthony J.; Marini, Bernard L.; Burke, Patrick W; Bixby, Dale L; Pettit, Kristen M; Benitez, Lydia L.
• Is Part Of: Leukemia research. Volume 102(2021)
• Publication Date: 2021-03
• Subjects: Acute myeloid leukemia -- High dose cytarabine -- Obesity -- Consolidation -- Outcomes; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2021.106517
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: The combined incidence of cycle delays, febrile neutropenia, or infection was similar in non-obese and obese patients receiving HIDAC. Long term outcomes were similar in non-obese patients compared to obese patients receiving high-dose cytarabine. For class III obesity, baseline dose-adjustments to chemotherapy were more common. Abstract: High dose cytarabine (HIDAC) consolidation has demonstrated a survival benefit in patients with acute myeloid leukemia (AML). The increasing prevalence of obesity and the toxicity risk with this therapy renders important the quantification of potential risks with weight-based dosing in this patient population. The American Society of Clinical Oncology published recommendations on chemotherapy dosing in obese patients, but patients with leukemia were excluded from analysis. This was a retrospective comparison of safety and efficacy outcomes in obese and non-obese patients with AML who received HIDAC consolidation. Thirty-nine (41.9 %) patients received dose adjusted HIDAC in cycle 1. Nine of the 40 patients in the obese group received HIDAC dose-adjusted for obesity. The combined incidence of cycle delays, febrile neutropenia, or documented infection was 41.5 % in non-obese patients compared to 57.5 % in obese patients (p = 0.127). The median overall survival (OS) and event free survival (EFS) were not reached in both cohorts. The estimated 36-month overall survival was 76.4 % (95 % CI 0.623−0.905) in non-obese patients, compared to 66.1 % (95 % CI 0.472−0.85) in obese patients. There were no significant differences in safety or efficacy outcomes for obese versus non-obese patients who received HIDAC consolidation. For class III obesity, baseline dose-adjustments were more common.