Comparison of the modified low-dose cytarabine and etoposide with decitabine therapy for elderly acute myeloid leukemia patients unfit for intensive chemotherapy

Abstract
To address the suboptimal outcomes of classical low-dose cytarabine (LDAC) with cytarabine ≤20 mg twice daily (BID) subcutaneously for 10 days in elderly acute myeloid leukemia (eAML) patients, we evaluated a modified LDAC (mLDAC) regimen. This regimen consisted of cytarabine 20 mg/m² BID subcutaneously combined with etoposide 50 mg BID orally for 14 days. To assess its feasibility, we compared the outcomes of 77 eAML patients who received mLDAC with those of 42 patients who received decitabine (DAC; 20 mg/m² intravenously daily for 5 days), which has shown better results than classical LDAC. The baseline characteristics of the two groups were well balanced. The mLDAC group achieved a higher complete response (CR) rate than the DAC group (46.8% vs. 19.0%, P < 0.01). Notably, unlike classical LDAC, mLDAC induced CR in patients with adverse cytogenetics, with the CR rate in this subgroup comparable to that of the DAC group (33.3% vs. 20.0%; P = 0.58). However, the mLDAC group experienced higher rates of mucositis, neutropenic fever, and invasive aspergillosis, with no significant difference in early mortality between the two groups (P > 0.05). The median overall survival was similar for both groups (8.7 months for mLDAC vs. 8.3 months for DAC, P = 0.35), likely because the higher CR rate in the mLDAC group was counterbalanced by the greater marrow response observed in the Decitabine DAC group. Our findings suggest that modifying classical LDAC can improve its outcomes, bringing them in line with those of DAC.