Efficacy of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) compared to Hyper-CVAD regimen as salvage chemotherapy in relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leuk

• Efficacy of CAG and Hyper-CVAD were similar for relapsed/refractory Ph−-T-ALL.
• Efficacy of CAG group for relapsed/refractory Ph−-B-ALL was lower than Hyper-CVAD.
• HD-CAG could not improve efficacy than CAG.
• CAG had lesser adverse event than Hyper-CVAD.

We treated 90 relapsed/refractory Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph−-ALL) patients with CAG regimen [cytarabine (10 mg/m2/12 h, days 1–14), aclarubicin (5–7 mg/m2/day, days 1–8), granulocyte colony-stimulating factor (200 μg/m2/day, days 1–14)], 82 relapsed/refractory Ph−-ALL patients were treated with increasing aclarubicin dose CAG (5–7 mg/m2/day, days 1–14, HD-CAG). 96 relapsed/refractory Ph−-ALL patients treated with Hyper-CVAD regimen (control group). After one therapy course, among all groups, there were no statistically significant differences with complete remission (CR) and overall response [OR, CR + partial remission (PR)] rates (P > 0.05). In CAG group, CR and OR rates for T-ALL exceeded those for B-ALL (P = 0.001, 0.007), while in HD-CAG and control groups, those were not statistically significantly different (P > 0.05). CR and OR rates of CAG group for B-ALL were lower than control group (P = 0.004, 0.012). Among all groups, there were no statistically significant differences with CR and OR rates for T-ALL (P > 0.05). CAG had lesser adverse event than Hyper-CVAD. The overall survival at 3 years for all groups were similar. Efficacy of CAG regimen was similar in comparison to Hyper-CVAD for relapsed/refractory Ph−-T-ALL. HD-CAG could not improve efficacy than CAG regimen.