Higher Idarubicin Dose During Consolidation Improves Leukemia-free Survival in AML

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A higher dose of idarubicin during consolidation therapy improves leukemia-free survival without increasing non-hematologic toxicity.
A higher dose of idarubicin during consolidation therapy improves leukemia-free survival without increasing non-hematologic toxicity.

SAN DIEGO A higher dose of idarubicin during consolidation therapy improves leukemia-free survival without increasing non-hematologic toxicity among adults with acute myeloid leukemia (AML), according to a study presented at the American Society of Hematology (ASH) 58th Annual Meeting and Exposition.1

To evaluate whether an increased idarubicin dose during consolidation therapy improves outcomes for adults with AML, researchers enrolled 293 patients with AML who achieved complete remission after 1 or 2 cycles of intensive induction therapy consisting of idarubicin, cytarabine, and etoposide. Participants were randomly assigned 1:1 to receive 2 cycles of consolidation therapy with cytarabine, etoposide, and idarubicin for either 2 or 3 days (standard and intensive arms, respectively).

After a median follow-up of 5.3 years, results showed that the higher dose of idarubicin was associated with 26% reduced risk of the disease recurring (hazard ratio, 0.74; 95% CI, 0.55-0.99; P = .045). The 3-year leukemia-free survival rate was 47% (95% CI, 40-56) with 3 days of idarubicin vs 35% (95% CI, 28-44) with 2 days.

"Idarubicin intensification improved leukemia-free survival," said Andrew Wei, MBBS, PhD, of the Alfred Hospital in Melbourne, Australia. “Idarubicin intensification also improved leukemia-free survival censored for hematopoietic stem cell transplantation.”

There was, however, no significant difference in 3-year overall survival between the 2 arms (hazard ratio, 0.75; 95% CI, 0.54-1.05; P = .092). The 3-year overall survival rates were 61% with intensive idarubicin vs 50% with standard dose.

“Idarubicin intensification significantly prolongs marrow suppression during consolidation,” added Dr Wei.

The durations of grades 3 to 4 neutropenia and thrombocytopenia were significantly longer in the intensive idarubicin arm, but there were no differences in grade 3 to 4 non-hematological toxicities.

RELATED: Venetoclax + LDAC Appears Active, Safe in Older Patients With AML

“Although intensive consolidation increased myelotoxicity, there was no evidence of increased cardiac complications,” said Dr Wei.

“Larger patient numbers are needed to determine the benefit of anthracycline intensification within genetic subgroups,” Dr Wei concluded.

Reference

  1. Kenneth B, Link E, Di Iulio J, et al. Increased idarubicin dosage during consolidation therapy for adult acute myeloid leukemia improves leukemia-free survival. Paper presented at: American Society of Hematology (ASH) 58th Annual Meeting and Exposition; December 3-6, 2016; San Diego, CA.

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