High‐dose cytarabine (24 g/m2) in combination with idarubicin (HiDAC‐3) results in high first‐cycle response with limited gastrointestinal toxicity in adult acute myeloid leukaemia. Issue 3 (27th February 2013)

• Record Type: Journal Article
• Authors: Low, M.; Lee, D.; Coutsouvelis, J.; Patil, S.; Opat, S.; Walker, P.; Schwarer, A.; Salem, H.; Avery, S.; Spencer, A.; Wei, A.
• Is Part Of: Internal medicine journal. Volume 43:Issue 3(2013)
• Page Start: 294
• Page End: 297
• Publication Date: 2013-02-27
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/j.1445-5994.2012.02868.x
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj2868-sec-0001" sec-type="section"> <title>Background/Aim</title> <p>Although induction chemotherapy comprising high‐dose cytarabine (HiDAC) in combination with idarubicin and etoposide or 'ICE' for adult acute myeloid leukaemia (AML) produces a complete remission rate of nearly 80%, gastrointestinal toxicity is significant. Omission of etoposide may produce similar clinical outcomes with potentially less gastrointestinal toxicity.</p> </sec> <sec id="imj2868-sec-0002" sec-type="section"> <title>Methods</title> <p>Fifty‐three consecutive patients aged 15–60 with newly diagnosed AML, receiving high‐dose cytarabine induction at the Alfred Hospital, Melbourne, were retrospectively analysed. Regimens included HiDAC‐3 (idarubicin 12 mg/m<sup>2</sup> day 1–3, cytarabine 3 gm/m<sup>2</sup> bd day 1, 3, 5, 7) or ICE (idarubicin 9 mg/m<sup>2</sup> day 1–3, cytarabine 3 g/m<sup>2</sup> bd day 1, 3, 5, 7, etoposide 75 mg/m<sup>2</sup> day 1–7). Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.03.</p> </sec> <sec id="imj2868-sec-0003" sec-type="section"> <title>Results</title> <p>Thirty‐one patients received HIDAC‐3 and 22 patients received ICE induction. HiDAC‐3 was better tolerated than ICE in terms of lower frequency of grade 3–4 nausea (0% vs 41%; <italic>P</italic> < 0.01), grade 3–4 diarrhoea (26% vs 55%; <italic>P</italic> = 0.05), lower rates of radiologically evident enterocolitis (6% vs 32%; <italic>P</italic> = 0.03) and less cumulative days of total parenteral nutrition use (1.2 vs 7.3 days; <italic>P</italic> < 0.01). Times to haematological recovery were similar between the two regimens. Thirty‐day mortality was 0% for HiDAC‐3 and 9% for ICE. Eighty‐four per cent of HiDAC‐3‐treated patients achieved complete remission after the first cycle of therapy, compared with 77% with ICE. No differences in survival were evident between the two regimens.</p> </sec> <sec id="imj2868-sec-0004" sec-type="section"> <title>Conclusions</title> <p>HiDAC‐3 is a clinically effective induction regimen for adult AML, producing a high rate of first‐cycle complete remission with less treatment‐related gastrointestinal toxicity than ICE.</p> </sec> </abstract>