Intense-dose Idarubicin Consolidation Prolongs LFS in AML

Consolidation treatment with intensive idarubicin prolonged leukemia-free survival (LFS) among adult patients with acute myeloid leukemia (AML) who achieved complete remission after induction therapy, according to a study published in the Journal of Clinical Oncology.¹

A previous study demonstrated that intensive daunorubicin induction therapy improved remission among adult patients with AML. The purpose of this trial was to determine whether intensive consolidation therapy with an increased anthracycline dose could further improve outcomes.

The trial included 293 patients with AML in complete remission after induction therapy who received 2 cycles of consolidation therapy with cytarabine, etoposide, and random assignment to 9 mg/m² idarubicin for 2 or 3 days.

The 3-year LFS was significantly longer in the intensive idarubicin arm at 47% (95% CI, 40-56%) compared with 35% in the standard arm (95% CI, 28-44%; hazard ratio [HR], 0.74; 95% CI, 0.55-0.99; P = .045). The median LFS was estimated to be 2.13 years with intensive idarubicin compared with 0.93 with standard-dose idarubicin.

Though there was a trend for prolonged 3-year overall survival with intense-dose vs standard-dose idarubicin, the difference was not significant (61% vs 50%, respectively; HR, 0.75; 95% CI, 0.54-1.05; P = .092).

The rate of non-hematologic toxicity was similar between arms, though the duration of grade 3 to 4 neutropenia and thrombocytopenia was longer with intensive idarubicin.

The findings of this study suggest that increasing the dose of idarubicin during consolidation therapy may improve LFS rates. According to the authors, this “represents a reasonable strategy to explore to further improve outcomes for this disease.”

Reference

1. Bradstock KF, Link E, Di Iulio J, et al. Idarubicin dose escalation during consolidation therapy for adult acute myeloid leukemia. J Clin Oncol. 2017 Apr 3. doi: 10.1200/JCO.2016.70.6374 [Epub ahead of print]