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Cytarabine plus idarubicin or daunorubicin as induction and consolidation
therapy for previously untreated adult patients with acute myeloid leukemia
PH Wiernik, PL Banks, DC Case , ZA Arlin, PO Periman, MB Todd, PS Ritch, RE Enck and AB Weitberg
Albert Einstein Cancer Center, Montefiore Medical Center, Bronx, NY 10467.
The purpose of this study was to determine the relative merits of
idarubicin and daunorubicin in acute myeloid leukemia (AML) therapy.
Thirty-two sites provided 214 previously untreated adults with AML aged 15
years or more who were randomized to receive for induction therapy
cytarabine 100 mg/m2/d as a continuous 7-day infusion plus either
daunorubicin 45 mg/m2/d (A + D) or idarubicin 13 mg/m2/d (A + I), daily on
the first three days of treatment. Postremission therapy consisted of two
courses of the induction regimen at the same daily doses, with the
anthracycline administered for 2 days and cytarabine for 5. The complete
response (CR) rates for evaluable patients were 70% (A + I) and 59% (A + D)
(P = .08). The difference in CR rates was significant in patients aged 18
to 50 years (88% for A + I, 70% for A + D, P = .035). Resistant disease was
a significantly more frequent cause of induction therapy failure with A + D
than with A + I. Hyperleukocytosis (white blood cell count greater than
50,000/microL) unfavorably affected the attainment of CR with A + D but not
with A + I. CR duration was significantly greater after A + I. CR duration
was significantly greater after A + I treatment, and the survival of all
randomized patients treated with A + I was significantly better than that
observed after A + D treatment (median 12.9 months v 8.7 months,
respectively, P = .038). Toxicity of the two treatments was similar,
although A + I patients experienced more prolonged myelosuppression during
consolidation therapy, and a greater incidence of mild chemical hepatitis
was observed in the A + I group. It is concluded that, at the doses and
schedule used in this study, A + I is superior to A + D for induction
therapy of AML in adults.
Volume 79,
Issue 2,
pp. 313-319,
01/15/1992
Copyright © 1992 by The American Society of Hematology
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