Retrospective analysis of three induction chemotherapy regimens in acute myeloid leukemia including CPX-351, cytarabine/daunorubicin with and without the addition of cladribine

Recently new treatments for acute myeloid leukemia (AML) emerged, including regimens like
CPX-351 and cladribine with cytarabine and daunorubicin (DA þ C), demonstrating improved
survival in patient subsets. This retrospective analysis is comparing the outcome of 124 patients
treated with cytarabine and daunorubicin (DA; n ¼ 54), CPX-351 (n ¼ 26) and DA þ C (n ¼ 44).
Complete response rate following one cycle of therapy was increased in DA þ C (62%) compared
to CPX-351 (42%) and DA (50%). CPX-351 demonstrated a significant increased survival post
allogenic stem cell transplantation against DA (hazard ratio (HR): 4.9; 95% confidence interval
(95%CI): 1.1–21, p ¼ 0.03). Median survival was reached for DA (5.6 years) but not for DA þ C or
CPX-351. Subgroup analysis showed that AML with myelodysplasia-related changes and therapy-
related AML treated with CPX-351 had increased survival compared to DA (HR: 5.2; 95%CI:
1.2–22; p ¼ 0.03). Our findings point twoards a CPX-351 superiority. However, the use of DA þ C
should be further evaluated in comparative studie.