In a nutshell
This study examined the effectiveness of an increased dose of idarubicin (Idamycin) during the consolidation phase of treatment for acute myeloid leukemia (AML). This study concluded that an increased dose of idarubicin was associated with improved leukemia-free survival, without increased side effects.
Some background
Anthracyclines are a common chemotherapy option for AML. Three days of daunorubicin (Cerubidine) is part of the standard chemotherapy induction (treatment to induce remission, a period without active disease). The common dose is 45 mg/m2. Increasing the dose of daunorubicin to 50 mg/m2 or 90 mg/m2 has shown mixed results. Some studies report improved remission rates. Other studies report no difference between higher doses. Idarubicin is another anthracycline. Several studies have noted improved outcomes in patients treated with idarubicin compared to daunorubicin.
Increasing the dose of cytarabine (Depocyt, another chemotherapy) has been shown to be effective during the consolidation phase (treatment to maintain remission). It is not yet clear whether idarubicin at any dose would be effective during the consolidation phase.
Methods & findings
This study examined whether an increased dose of idarubicin would be effective during consolidation for AML. The study included 422 patients. All were treated with 2 cycles of a combination of idarubicin, cytarabine, and etoposide (the ICE regimen) during induction. 82% of these patients achieved complete remission (CR). 93% achieved a CR after the first cycle. These patients were randomly assigned to one of 2 consolidation groups. Both groups were treated with cytarabine and etoposide. Group 1 also received 2 days of idarubicin. Group 2 received 3 days of idarubicin. Patients were followed for an average of 5.3 years.
82% of group 1 and 66% of group 2 completed the 2 planned consolidation cycles. 19% of patients in group 2 missed the second cycle due to side effects compared to 9% of patients in group 1. Patients in group 2 experienced longer episodes of low white blood cells and low platelets (cells involved in blood clotting). There were no differences in other types of side effects between the groups.
47% of patients in group 3 were leukemia-free at 3 years. In comparison, 35% of group 1 was leukemia-free. 57% of group 2 were alive at 5 years, compared to 47% of patients in group 1.
The bottom line
This study concluded that an increased dose of idarubicin during consolidation was associated with improved leukemia-free survival, without an increase in specific side effects.
Published By :
Journal of clinical oncology
Date :
Apr 03, 2017