Summary
Conventional-dose Ara-C (200 mg/m2 d 1–5) combined with idarubicin (12 mg/m2 d 1–3) was employed as remission induction and consolidation therapy in 23 elderly AML patients with a median age of 66 years (range, 60–75) with AML according to the FAB criteria (M1n=3, M2n=10, M4n=6, M5n=2, M6n=2), eligible for the study. In seven patients earlier MDS had been documented by previous bone marrow aspirates. The CR rate after one induction course was 65% (15/23). Toxicity was acceptable, with four patients dying during the chemotherapy-induced hypoplasia (4/23). Although 80% of the CR patients received two additional cycles of Ara-C and idarubicin as consolidation therapy, only two patients are still in continuous complete remission more than 12 months after achieving CR. The median disease-free survival of the CR patients was 11.5 months and the median survival of the entire group was 10 months. We conclude that conventional dose Ara-C/idarubicin is an effective protocol for inducing complete remission in elderly patients with AML, but that consolidation therapy consisting of two courses of the same regimen does not produce a relevant rate of long-term disease-free survival.
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Berman E, Heller G, Santorsa JA, McKenzie S, Gee T, Kempin S, Gulati S, Andreeff M, Kolitz J, Gabrilove J, Reich L, Mayer K, Keefe D, Trainor K, Schluger A, Penenberg D, Raymond V, O'Reilly R, Jhanwar S, Young C, Clarkson B (1991) Results of a randomized trial comparing idarubicin and cytosine arabinoside with daunorubicin and cytosine arabinoside in adult patients with newly diagnosed acute myelogenous leukemia. Blood 77:1666–1674
Büchner T, Hiddemann W, Maschmeyer G, Ludwig W, Löffler H, Nowrosian M, Aul C, Heinecke A for the AMLCG (1990) How to improve therapy for adult acute myeloid leukemia: studies of the AML Cooperative Group in the Federal Republic of Germany. J Cancer Res Clin Oncol 116:97–99
Champlin RE, Gajewski JL, Golde DW (1989) Treatment of acute myelogenous leukemia in the elderly. Semin Oncol 16:51–56
Christoffersen PS, Rasmussen KK, Hermansen K (1988) Cardiovascular effects of doxorubicin (adriamycin) and 4-demethoxydaunorubicin (idarubicin) in the conscious rat. Pharmacol Toxicol 62:54–56
Detourmignies L, Wattel E, Lai JL, Bauters F, Fenaux P (1993) Is there still a role for low-dose cytosine arabinoside in de novo acute myeloid leukemia in the elderly? A report on 77 cases. Ann Hematol 66:235–240
Hamblin T (1992) The treatment of acute myeloid leukaemia preceded by the myelodysplastlic syndrome. Leuk Res 16:101–108
Harousseau JL, Rigal-Huguet F, Hurteloup P, Guy H, Milpied N, Pris J (1989) Treatment of acute myeloid leukemia in elderly patients with oral idarubicin as a single agent. Eur J Haematol 42:182–185
Heyll A, Aul C, Heyll U, Schneider W (1987) Low-dose cytosine arabinoside in patients with acute myeloblastic leukemia and myelodysplastic syndrome. Haematol Blood Transfus 30:322–325
Hoyle CF, de Bastos M, Wheatley K, Sherrington PD, Fischer PJ, Rees JKH, Gray R, Hayhoe FGJ (1989) AML associated with previous cytotoxic therapy, MDS or myeloproliferative disorders: results from the MRC's 9th AML trial. Br J Haematol 72:45–53
Lazarus HM, Vogler WR, Burns CP, Winton EF (1989) Highdose cytosine arabinoside and daunorubicin as primary therapy in elderly patients with acute myelogenous leukemia. Cancer 63:1055–1059
Montastruc M, Reiffers J, Stoppa AM, Sotto JJ, Corront B, Marit G, Maraninchi D, Michallet M, Gastaut JA, Broustet A, Hollard D, Carcassonne Y (1990) Treatment of acute myloid leukemia in elderly patients: the influence of maintenance therapy (BGM 84 protocol). Nouv Rev Fr Hematol 32:147–152
Schiller G, Gajewski J, Nimer S, Territo M, Ho W, Lee M, Champlin R (1992) A randomized study of intermediate versus conventional-dose cytarabine as intensive induction for acute myelogenous leukaemia. Br J Haematol 81:170–177
Sebban C, Archimbaud E, Coiffier B, Guyotat D, Treille-Ritouet D, Maupas J, Fiere D (1988) Treatment of acute myeloid leukemia in elderly patients: a retrospective study. Cancer 61:227–231
Vogler WR, Velez-Garcia E, Weiner RS, Flaum MA, Bartolucci AA, Omura GA, Gerber MC, Banks PLC (1992) A phase-Ill trial comparing idarubicin and daunorubicin in combination with cytarabine in acute myelogenous leukemia: a Southeastern Cancer Study Group study. J Clin Oncol 10:1103–1111
Wahlin A, Hörnsten P, Jonsson H (1991) Remission rate and survival in acute myeloid leukemia: impact of selection and chemotherapy. Eur J Haematol 46:240–247
Wiernik PH, Banks PLC, Case DC, Arlin ZA, Periman PO, Todd MB, Ritch PS, Enck RE, Weitberg AB (1992) Cytarabine plus idarubicin or daunorubicin as induction and consolidation therapy for previously untreated adult patients with acute myeloid leukemia. Blood 79:313–319
Yates J, Glidewell O, Wiernik P, Cooper MR, Steinberg D, Dosik H, Levy R, Hoagland C, Henry P, Gottlieb A, Cornell C, Berenberg J, Hutchinson JL, Raich P, Nissen N, Ellison RR, Frelick R, James GW, Falkson G, Silver RT, Haurani F, Green M, Henderson E, Leone L, Holland JF (1982) Cytosine arabinoside with daunorubicin or adriamycin for therapy of acute myelocytic leukemia: a CALGB study. Blood 60:454–462
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Heyll, A., Aul, C., Gogolin, F. et al. Results of conventional-dose cytosine arabinoside and idarubicin in elderly patients with acute myeloid leukemia. Ann Hematol 68, 279–283 (1994). https://doi.org/10.1007/BF01695033
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DOI: https://doi.org/10.1007/BF01695033