title: Escalation of daunorubicin and addition of etoposide in the ADE regimen in acute myeloid leukemia patients aged 60 years and older: Cancer and Leukemia Group B Study 9720.
abstract: Untreated de novo (n=421) and secondary (n=189) acute myeloid leukemia (AML) patients ≥60 years received intensified chemotherapy, including daunorubicin 60 mg/m(2) and etoposide 100 mg/m(2) during days 1, 2, 3 with cytarabine 100 mg/m(2) during days 1-7, with a second induction if needed and one consolidation course with these drugs and doses for 2, 2 and 5 days, respectively. In all, 287 (47%) achieved complete remission (CR), 136 (22%) died and 187 (31%) were non-responders. CR rates were 27, 44 and 52% for complex karyotypes, rare aberrations and neither (P<0.001), 52 and 37% for de novo and secondary AML (P=0.003), and 53 and 42% for age 60-69 and ≥70 years (P=0.015). In multivariable analysis, CR predictors included non-complex/non-rare karyotypes (P<0.001), de novo AML (P<0.001), better performance status (PS) (P<0.001) and younger age (P=0.001). Disease-free (DFS) and overall (OS) survival medians were 6.8 (95% CI: 6.2, 7.8) and 7.2 (95% CI: 6.4, 8.6) months. In multivariable analysis, DFS was shorter for complex karyotypes (P<0.001) and increasing white blood count (WBC) (P<0.001) and age (P=0.038), and OS for complex karyotypes (P<0.001), increasing WBC (P=0.001) and age (P<0.001), poorer PS (P<0.001) and secondary AML (P=0.010). Outcomes and prognostic factors were similar to those in previous Cancer and Leukemia Group B studies.
authors.affiliation: University of Maryland, Department of Medicine, Baltimore, MD 21201, USA. mbaer@umm.edu
authors.forename: M R
authors.initials: MR
authors.lastname: Baer
authors.forename: S L
authors.initials: SL
authors.lastname: George
authors.forename: B L
authors.initials: BL
authors.lastname: Sanford
authors.forename: K
authors.initials: K
authors.lastname: Mrózek
authors.forename: J E
authors.initials: JE
authors.lastname: Kolitz
authors.forename: J O
authors.initials: JO
authors.lastname: Moore
authors.forename: R M
authors.initials: RM
authors.lastname: Stone
authors.forename: B L
authors.initials: BL
authors.lastname: Powell
authors.forename: M A
authors.initials: MA
authors.lastname: Caligiuri
authors.forename: C D
authors.initials: CD
authors.lastname: Bloomfield
authors.forename: R A
authors.initials: RA
authors.lastname: Larson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D003630:Daunorubicin