Does the choice of anthracycline and transplant impact outcomes for patients with acute myeloid leukemia?

This study aimed to investigate the outcomes for patients with acute myeloid leukemia based on anthracycline and transplant type.  

This study concluded that the long-term outcomes for these patients were similar regardless of anthracycline and transplant choice.  

Daunorubicin (Cerubidine), mitoxantrone (Novantrone), idarubicin (Idamycin) are a type of chemotherapy known as anthracyclines. They are used for the treatment of acute myeloid leukemia (AML). Cytarabine (Cytosar-u) and etoposide (Etopophos) are other chemotherapies used for the treatment of AML.  

Allogeneic hemopoietic stem cell transplant (allo-HSCT) is a treatment where the patient receives stem cells from a matched donor to replace healthy cells lost during cancer treatment. Autologous HSCT is where the cells come from the patient rather than a donor. HSCT can be used after initial cancer treatments.  

It was unknown if the outcome for AML patients would vary based on the choice of anthracycline combined with cytarabine and etoposide and choice of transplant.  

This study involved 2157 patients with AML. All patients received standard-dose cytarabine and etoposide for induction chemotherapy and intermediate-dose cytarabine for consolidation. Patients were split into groups and either received daunorubicin, mitoxantrone or idarubicin. 

Patients who achieved complete remission (no signs of cancer) with complete (CR) or incomplete (CRi) recovery went on to receive allo-HSCT if they had a sibling donor. In other cases, they received an autologous HSCT (transplant of their own stem cells). Patients were followed for an average of 11 years.  

The 5-year overall survival (OS) rate was 33.2%. OS rate was 30.1% at 10 years and 28% at 15 years. There was no significant difference in 10-year OS between the three groups (36.7% with daunorubicin, 41.8% with mitoxantrone and 43.3% with idarubicin). In patients aged 15-45 years old, no treatment difference regarding OS was observed. In patients aged 46-60 years, mitoxantrone and idarubicin groups had a longer OS when compared to the daunorubicin group. 

The 10-year disease-free survival (DFS) was also not significantly different between groups. DFS was 31.6% with daunorubicin, 36.9% with mitoxantrone and 36.9% with idarubicin. 

In younger patients without favorable risk who achieved a CR/CRi after induction chemotherapy, those with a matched donor had higher 10-year OS and 15 year OS rates than those without a matched donor. In older patients who reached CR/CRi, the long-term outcomes of those with or without a donor were similar. 

This study concluded that the long-term outcomes for patients with AML were similar regardless of anthracycline or transplant type.