title: High-dose cytarabine induction is well tolerated and active in patients with de novo acute myeloid leukemia older than 60 years.
abstract: BACKGROUND
  High-dose cytarabine (HiDAC) is safe and very effective in younger patients with acute myeloid leukemia (AML), but it generally is not well tolerated in the elderly.
  
  
  METHODS
  The authors explored the safety and tolerability of a modified HiDAC induction regimen consisting of 6 daily doses of cytarabine at 2 g/m(2) in combination with 3 daily doses of daunorubicin at 45 mg/m(2) in 59 consecutive patients aged >60 years who had de novo AML diagnosed between July 1996 and February 2005.
  
  
  RESULTS
  The median patient age was 68 years (range, 60-86 years). The regimen was well tolerated. Infections were common and occurred in 39% of patients, but cerebellar toxicities occurred in only 7% of patients and were reversible. The day-30 induction-related mortality rate was 10%. Overall, 69% of patients achieved complete remissions (CR), and 80% received up to 3 consolidations with HiDAC. The median follow-up for surviving patients was 53 months (range, 17-114 months). The median overall survival was 15.3 months (range, 1-114 months), and the relapse-free survival was 13.8 months (range, 1-113 months). Survival for patients who achieved CR was 27 months (range, 2-114 months).
  
  
  CONCLUSIONS
  The modified HiDAC regimen was well tolerated in patients aged >60 years with AML and was associated with low induction mortality and high rates of CR. Nevertheless, these high remissions still were associated with poor overall outcomes.
authors: Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia 30322, USA. marella@emory.edu
authors: Martha
authors: M
authors: Arellano
authors: Elliott
authors: E
authors: Winton
authors: Lin
authors: L
authors: Pan
authors: Lisa
authors: L
authors: Lima
authors: Mourad
authors: M
authors: Tighiouart
authors: Kapil
authors: K
authors: Bhalla
authors: Leonard T
authors: LT
authors: Heffner
authors: Jessica
authors: J
authors: Neely
authors: Donald
authors: D
authors: Hutcherson
authors: Morgan
authors: M
authors: McLemore
authors: Amelia
authors: A
authors: Langston
authors: H Jean
authors: HJ
authors: Khoury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016019:Survival Analysis
chemical_list: D003561:Cytarabine