Researchers Identify Potential Predictors of Rash During AML Induction Therapy

Having a certain laboratory abnormality may be an indicator of development of rash while receiving a commonly used induction chemotherapy regimen for acute myeloid leukemia (AML), suggest study findings.¹

The combination of cytarabine (ara-C; cytosine arabinoside) and idarubicin (Idamycin) continues to serve as the cornerstone of induction treatment for AML.² These new retrospective findings, published in Cancer Diagnosis & Prognosis, offer valuable insight into predictors for the common side effect associated with cytarabine and idarubicin in these patients, explained the present researchers.¹

Rash is a common side effect of an idarucibin and cytarabine induction intervention for AML | image credit: gballgiggs - stock.adobe.com

“Rash can cause significant physical discomfort and psychological distress, profoundly affecting the health-related quality of life of patients,” wrote the authors.“Additionally, worsening skin symptoms may impede the effective management of cancer chemotherapy. Therefore, identifying the risk factors for rash associated with cytarabine and idarubicin induction therapy is crucial for implementing timely and appropriate measures to address this issue.”

Among 97 patients with AML receiving the induction chemotherapy regimen, having pre-existing leukopenia was significantly associated with the development of rash (OR: 3.3; 95% CI, 1.27-8.53; P = .033). Nearly 40% of patients had leukopenia prior to initiating the chemotherapy regimen.

Patients received 24-hour infusions of cytarabine at 100 mg/m² for 7 days and 30-minute infusions of idarubicin at 12 mg/m² for 3 days. Over half (58.8%) of patients developed rash throughout treatment, which was treated with corticosteroids or antihistamines. Among those who developed rash, 40.4% had grade 1 symptoms, 54.4% had grade 2 symptoms, and 3 patients had grade 3 symptoms. The rate of rash observed in the analysis, explained the researchers, is similar to previous study findings that showed an incidence rate of 61% with induction cytarabine, idarubicin, and cladribine.

The majority of patients included in the study had an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0 (42.3%) or 1 (47.4%). Notably, patients with better performance status had a higher incidence of rash. The findings showed that those with an ECOG PS score of 0 were significantly more likely than those with an ECOG PS of ≥1 to develop rash (OR: 1.72; 95% CI, 1.10-6.79; P = .033).

The researchers also performed a matched-pair analysis, in which patients were divided into 2 groups based on whether or not they had pre-existing leukopenia, and they were then matched 1:1 according to age and PS score of 0. Results of the analysis showed that the original observation of significantly higher rates of rash associated with an ECOG PS score of 0 disappeared (73.3% vs 50%; P = .110).

“The disappearance of the significant difference in the incidence of rash between the good PS and poor PS groups in the matched pair analysis may be due to the lack of influence of pre-existing leukopenia,” described the researchers.“Consequently, pre-existing leukopenia emerges as the sole significant risk factor for rash associated with cytarabine and idarubicin induction therapy in patients with AML.”

References:

1. Uchida M, Ishida S, Mochizuki E, et al. Risk factor for rash in patients receiving cytarabine and idarubicin induction therapy for acute myeloid leukemia. CDP. Published online September 1, 2024. doi:10.21873/cdp.10372
2. Zhang Y, Chen Q, Weng X, et al. Optimization of idarubicin and cytarabine induction regimen with homoharringtonine for newly diagnosed AML based on the peripheral blast clearance rate: first result of the multicenter, randomized, Phase 3 trial (RJ-AML 2016). Blood. 2023;142(S1):829. doi:10.1182/blood-2023-179311