Anthracycline Dose Intensification in Acute Myeloid Leukemia

• Published in: The New England journal of medicine Vol. 361; no. 13; pp. 1249 - 1259
• Main Authors: Fernandez, Hugo F, Sun, Zhuoxin, Yao, Xiaopan, Litzow, Mark R, Luger, Selina M, Paietta, Elisabeth M, Racevskis, Janis, Dewald, Gordon W, Ketterling, Rhett P, Bennett, John M, Rowe, Jacob M, Lazarus, Hillard M, Tallman, Martin S
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 24-09-2009
• Subjects: Adolescent; Adult; Age Factors; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Bone marrow; Chemotherapy; Combined Modality Therapy; Consolidation; Cytarabine - administration & dosage; Daunorubicin - administration & dosage; Daunorubicin - adverse effects; Female; fms-Like Tyrosine Kinase 3 - genetics; General aspects; Hematologic and hematopoietic diseases; Histone-Lysine N-Methyltransferase; Humans; Infusions, Intravenous; Kaplan-Meier Estimate; Kinases; Leukemia, Myelomonocytic, Acute - drug therapy; Leukemia, Myelomonocytic, Acute - genetics; Leukemia, Myelomonocytic, Acute - mortality; Leukemia, Myelomonocytic, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Mutation; Myeloid-Lymphoid Leukemia Protein - genetics; Proportional Hazards Models; Remission Induction - methods; Risk Factors; Stem Cell Transplantation; Young Adult; Medicine; Acute myelogenous leukemia; Intensification; Malignant hemopathy; Anthracyclins; Dose; Cancer
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0904544

Patients with AML who were between 17 and 60 years of age were randomly assigned to receive induction therapy with the standard dose of daunorubicin or twice the standard dose; the two groups also received a standard dose of cytarabine. Rates of complete remission and overall survival were best in the high-dose group, especially among patients with a favorable or an intermediate cytogenetic risk profile.
Patients with AML who were between 17 and 60 years of age were randomly assigned to receive induction therapy with the standard dose of daunorubicin or twice the standard dose. Rates of complete remission and overall survival were best in the high-dose group.
The survival of patients with acute myeloid leukemia (AML) is affected by many variables, including therapy that induces complete remission and appropriate consolidation therapy. Currently, anthracycline plus cytarabine is the usual induction therapy for patients with AML.
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The widely used intravenous combination of daunorubicin (at a dose of 45 mg per square meter of body-surface area), given daily for 3 days, and cytarabine (at a dose of 100 mg per square meter), given daily for 7 days, results in complete remission in 50 to 75% of patients.
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,
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Neither the addition of other drugs to daunorubicin and cytarabine
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nor intensification . . .