Prospective Study Comparing Idarubicin and Daunorubicin in Elderly Patients with Acute Myeloid Leukemia

Abstract

There is general agreement about the use of a combination of cytosine arabinoside (Ara-C) and anthracycline as induction chemotherapy for patients with acute myeloid leukemia (AML). Cytosine arabinoside is usually given as a continuous infusion (100–200 mg/m² per day) for 7–10 days. Daunorubicin (DNR) is the most commonly used anthracycline and is usually infused for 3 days (45–60 mg/m² per day). Using such a combination, complete remission (CR) is achieved in 65%–80% of young adult patients but the CR rate is lower in elderly patients, varying from 40% to 70% [6]. This latter lower CR rate is due to a high proportion of patients who fail to enter remission either because they die during induction treatment (infection, cardial dysfunction, etc.) or their leukemic cells are not sensitive to chemotherapy [6]. In order to increase the CR rate in elderly patients, several therapeutic strategies have been proposed. Hematopoietic growth factors such as GM-CSF or G-CSF may shorten the duration of granulocytopenia following chemotherapy and decrease the number of early deaths [3]. New intercalating agents may be used instead of DNR for both increasing the antileukemic efficacy and decreasing the mortality due to cardiac toxicity. Idarubicin (IDA) (4-demethoxydaunorubicin) has been recently introduced as treatment for AML patients. Its safety and antileukemic activity have been reported in some phase I — phase II studies where IDA was used either alone [7] or in combination with Ara-C [1, 5, 8]. The preliminary results from some ongoing prospective studies indicate that IDA is at least as efficient as DNR for adult patients with AML [2, 10, 12, 13]. We report herein a prospective study comparing IDA and DNR in AML patients aged between 55 and 75 years. Our preliminary results are similar to those reported elsewhere in adult patients and confirm that IDA is at least as effective as DNR.