title: Remission induction in children with acute non-lymphocytic leukemia using cytosine arabinoside and doxorubicin or daunorubicin: a report from the Childrens Cancer Study Group.
abstract: Four hundred ninety evaluable patients were treated on an induction regimen consisting of two to four courses of cytosine arabinoside plus an anthracycline. Overall, 78% of patients went into remission, 10% died during induction, and 12% were induction failures. For the first 152 patients, courses consisted of 7 days continuous infusion with cytosine arabinoside (Ara-C, 100 mg/m2) and 3 days of doxorubicin (30 mg/m2). Because of unacceptable toxicity, particularly for children less than 3 years of age, the anthracycline was changed to daunorubicin, and the doses of both induction drugs for children under 3 was reduced. For children aged 3 years and older the change in anthracycline was associated with a significant increase in induction failures (7% to 16%, P = .04) and a decrease in deaths (15% to 8%, P = .09). For younger children, for whom doses were also changed, the effect was greater; Mortality decreased from 29% to 1% (P less than .0001), and the remission induction rate increased from 66% to 88% (P = .005). The therapy modifications also influenced survival following remission induction: Daunorubicin-treated patients, aged 3 years and over, did significantly better than those given doxorubicin (P = .03), but the opposite was seen in younger children (P = .06). Gastrointestinal and skin toxicities and septicemia were significantly more common when doxorubicin was being used, but the extent of myelosuppression was similar for the two anthracyclines.
authors.affiliation: University of Southern California School of Medicine, Los Angeles.
authors.forename: J D
authors.initials: JD
authors.lastname: Buckley
authors.forename: B C
authors.initials: BC
authors.lastname: Lampkin
authors.forename: M E
authors.initials: ME
authors.lastname: Nesbit
authors.forename: I D
authors.initials: ID
authors.lastname: Bernstein
authors.forename: S A
authors.initials: SA
authors.lastname: Feig
authors.forename: J H
authors.initials: JH
authors.lastname: Kersey
authors.forename: S
authors.initials: S
authors.lastname: Piomelli
authors.forename: T
authors.initials: T
authors.lastname: Kim
authors.forename: G D
authors.initials: GD
authors.lastname: Hammond
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D003561:Cytarabine; D004317:Doxorubicin; D003630:Daunorubicin