title: Superior long-term outcome with idarubicin compared with high-dose daunorubicin in patients with acute myeloid leukemia age 50 years and older.
abstract: OBJECTIVE
  Although standard chemotherapy remains associated with a poor outcome in older patients with acute myeloid leukemia (AML), it is unclear which patients can survive long enough to be considered as cured. This study aimed to identify factors influencing the long-term outcome in these patients.
  
  
  METHODS
  The study included 727 older patients with AML (median age, 67 years) treated in two idarubicin (IDA) versus daunorubicin (DNR) Acute Leukemia French Association trials. Prognostic analysis was based on standard univariate and multivariate models and also included a cure fraction model to focus on long-term outcome.
  
  
  RESULTS
  Age, WBC count, secondary AML, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and adverse-risk and favorable-risk AML subsets (European LeukemiaNet classification) all influenced complete remission (CR) rate and overall survival (OS). IDA random assignment was associated with higher CR rate, but not with longer OS (P = .13). The overall cure rate was 13.3%. Older age and ECOG-PS more than 1 negatively influenced cure rate, which was higher in patients with favorable-risk AML (39.1% v 8.0% in adverse-risk AML; P < .001) and those treated with IDA (16.6% v 9.8% with DNR; P = .018). The long-term impact of IDA was still observed in patients younger than age 65 years, although all of the younger patients in the DNR control arm received high DNR doses (cure rate, 27.4% for IDA v 15.9% for DNR; P = .049). In multivariate analysis, IDA random assignment remained associated with a higher cure rate (P = .04), together with younger age and favorable-risk AML, despite not influencing OS (P = .11).
  
  
  CONCLUSIONS
  In older patients with AML, younger age, favorable-risk AML, and IDA treatment predict a better long-term outcome.
authors.affiliation: Department of Hematology, Hôpital Avicenne, AP-HP, 125 Route de Stalingrad, 93000 Bobigny, France. claude.gardin@avc.aphp.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Gardin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Cécile
authors.initials: C
authors.lastname: Pautas
authors.forename: Pascal
authors.initials: P
authors.lastname: Turlure
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.forename: Bruno
authors.initials: B
authors.lastname: Quesnel
authors.forename: Thierry
authors.initials: T
authors.lastname: de Revel
authors.forename: Stéphane
authors.initials: S
authors.lastname: de Botton
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gachard
authors.forename: Aline
authors.initials: A
authors.lastname: Renneville
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boissel
authors.forename: Claude
authors.initials: C
authors.lastname: Preudhomme
authors.forename: Christine
authors.initials: C
authors.lastname: Terré
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.forename: Dominique
authors.initials: D
authors.lastname: Bordessoule
authors.forename: Karine
authors.initials: K
authors.lastname: Celli-Lebras
authors.forename: Sylvie
authors.initials: S
authors.lastname: Castaigne
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003630:Daunorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D013995:Time; D016896:Treatment Outcome
chemical_list: D015255:Idarubicin; D003630:Daunorubicin