Cladribine in the remission induction of adult acute myeloid leukemia: where do we stand?

Ann Hematol. 2019 Mar;98(3):561-579. doi: 10.1007/s00277-018-3562-8. Epub 2018 Nov 23.

Abstract

The combination of cytarabine and an anthracycline has been the standard of care for the induction of remission in acute myeloid leukemia (AML). The response to treatment and survival of adult patients with AML are still variable and depend on multiple factors. Therefore, there have been many efforts to improve the response to treatment and survival rates by either increasing the cytarabine dose or adding a third agent to the standard induction chemotherapy regimen. Unfortunately, attempts to improve response and survival have been mostly unsuccessful. Recent clinical trials and retrospective studies explored the addition of cladribine to standard induction chemotherapy for AML. Some of these studies showed higher rates of complete remission, and one showed improved survival. In this review, we will discuss the antileukemic properties of cladribine and summarize the recent clinical data regarding its incorporation into the induction therapy for adult AML.

Keywords: Acute myeloid leukemia; Chemotherapy; Cladribine; Induction; Remission.

Publication types

  • Review

MeSH terms

  • Anthracyclines / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cladribine* / administration & dosage
  • Cladribine* / adverse effects
  • Cladribine* / chemistry
  • Cladribine* / pharmacokinetics
  • Clinical Trials as Topic
  • Cytarabine / administration & dosage
  • Dose-Response Relationship, Drug
  • Drug Interactions
  • Heart Diseases / chemically induced
  • Hematologic Diseases / chemically induced
  • Humans
  • Induction Chemotherapy
  • Leukemia, Myeloid, Acute / drug therapy*
  • Liposomes
  • Meta-Analysis as Topic
  • Mucositis / chemically induced
  • Multicenter Studies as Topic
  • Neoplasms, Second Primary / chemically induced
  • Remission Induction
  • Survival Rate
  • Treatment Outcome

Substances

  • Anthracyclines
  • Liposomes
  • Cytarabine
  • Cladribine