Comparison of anthracyclines used for induction chemotherapy in patients with FLT3-ITD-mutated acute myeloid leukemia. (May 2018)

• Record Type: Journal Article
• Authors: Choi, Eun-Ji; Lee, Je-Hwan; Lee, Jung-Hee; Park, Han-Seung; Ko, Sun-Hye; Hur, Eun-Hye; Moon, Juhyun; Goo, Bon-Kwan; Kim, Yeonhee; Seol, Miee; Lee, Young-Shin; Kang, Young-Ah; Jeon, Mijin; Woo, Ji Min; Lee, Kyoo-Hyung
• Is Part Of: Leukemia research. Volume 68(2018)
• Page Start: 51
• Page End: 56
• Publication Date: 2018-05
• Subjects: Acute myeloid leukemia -- FLT3-ITD -- Induction chemotherapy -- Anthracycline; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2018.03.006
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: FLT3 -ITD-mutated AML patients benefited from high-dose daunorubicin. High-dose daunorubicin seems to yield better results than idarubicin. The results of in vitro studies support these findings. Abstract: This retrospective analysis compared anthracyclines (as part of an induction regimen) in 128 newly diagnosed FLT3 -ITD-mutated AML patients. Induction regimens comprised high-dose daunorubicin (HD-DN; 90 mg/m 2 /d × 3d; n = 44), standard-dose daunorubicin (SD-DN; 45 mg/m 2 /d × 3d; n = 51), or idarubicin (IDA; 12 mg/m 2 /d × 3d; n = 33) in combination with cytarabine (100–200 mg/m 2 /d × 7d). Fifty-three patients showing persistent leukemia on interim bone marrow examination received a second course of induction chemotherapy comprising 2 days of daunorubicin (45 mg/m 2 /d) or IDA (8 or 12 mg/m 2 /d) in addition to 5 days of cytarabine. Complete remission (CR) rates were 77.3%, 56.9%, and 69.7% for HD-DN, SD-DN, and IDA, respectively ( P = 0.101; HD-DN vs. SD-DN, P = 0.036; HD-DN vs. IDA, P = 0.453; IDA vs. SD-DN, P = 0.237). The HD-DN showed higher overall survival (OS) and event-free survival (EFS) than SD-DN and IDA: the differences between HD-DN and SD-DN ( P = 0.009 for OS and P = 0.010 for EFS) were statistically significant. Results of in vitro studies using FLT3 -ITD-mutated cell lines supported these findings. In conclusion, HD-DN improved the CR rate, OS, and EFS of FLT3 -ITD-mutated AML patients. HD-DN also tended to yield better outcomes than IDA, though the difference was not significant. The superiority of HD-DN over IDA should be confirmed in future studies.