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Table 1 Possible mechanisms by which leukemic stem cells survive after ARA-C treatment and approaches to optimize therapy

From: Optimization of cytarabine (ARA-C) therapy for acute myeloid leukemia

  Treatment to reduce  
Survival mechanisms leukemic cell survival References
12-h interval between ARA-C infusions too long reduce interval [16]
deficiency in CdR kinase 3-DU + ARA-C [2022]
increase in dCTP 3-DU + ARA-C [2022]
increase CR deaminase THU + ARA-C [24, 25]
CR deaminase inactivation of ARA-C in liver THU + ARA-C [24, 25]
block in cell cycle progression G1 to S phase intermittent ARA-C, DAC [30]
high frequency of leukemic stem cells 3-DU + ARA-C, DAC prime ARA-C [22, 36]
resistance to apoptosis DAC prime ARA-C, DAC [36, 40]
  1. Abbreviations: h hour, 3-DU 3-deazauridine, THU tetrahydrouridine, DAC decitabine.