A comparison of clofarabine with ara-C, each in combination with daunorubicin as induction treatment in older patients with acute myeloid leukaemia.
The study was designed to compare clofarabine plus daunorubicin vs daunorubicin/ara-C in older patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS). Eight hundred and six untreated patients in the UK NCRI AML16 trial with AML/high-risk MDS (median age, 67 years; range 56-84) and normal serum creatinine were randomised to two courses of induction chemotherapy with either daunorubicin/ara-C (DA) or daunorubicin/clofarabine (DClo). Patients were also included in additional randomisations; ± one dose of gemtuzumab ozogamicin in course 1; 2v3 courses and ± azacitidine maintenance. The primary end point was overall survival. The overall response rate was 69% (complete remission (CR) 60%; CRi 9%), with no difference between DA (71%) and DClo (66%). There was no difference in 30-/60-day mortality or toxicity: significantly more supportive care was required in the DA arm even though platelet and neutrophil recovery was significantly slower with DClo. There were no differences in cumulative incidence of relapse (74% vs 68%; hazard ratio (HR) 0.93 (0.77-1.14), P=0.5); survival from relapse (7% vs 9%; HR 0.96 (0.77-1.19), P=0.7); relapse-free (31% vs 32%; HR 1.02 (0.83-1.24), P=0.9) or overall survival (23% vs 22%; HR 1.08 (0.93-1.26), P=0.3). Clofarabine 20 mg/m2given for 5 days with daunorubicin is not superior to ara-C+daunorubicin as induction for older patients with AML/high-risk MDS.
Department of Haematology, Cardiff University School of Medicine, Cardiff, UK.
A K
AK
Burnett
Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, UK.
N H
NH
Russell
Centre for Trails Research, Cardiff University, Cardiff, UK.
R K
RK
Hills
Department of Haematology, University Hospital of Wales Cardiff, Cardiff, UK.
J
J
Kell
Department of Haematology, Rigshospitalet, Copenhagen, Denmark.
O J
OJ
Nielsen
Department of Haematology, Christie Hospital, Manchester, UK.
M
M
Dennis
Department of Haematology, Blackpool Victoria Hospital, Blackpool, UK.
P
P
Cahalin
Department of Haematology, Kent & Canterbury Hospital, Canterbury, Kent, UK.
C
C
Pocock
Department of Haematology, Castle Hill Hospital, Hull, UK.
S
S
Ali
Centre for Trails Research, Cardiff University, Cardiff, UK.
S
S
Burns
Department of Immunology, University of Birmingham, Birmingham, UK.
S
S
Freeman
Department of Haematology, Heartlands Hospital, Birmingham, UK.
D
D
Milligan
Department of Haematology, Royal Liverpool University Hospital, Liverpool, UK.
R E
RE
Clark
D000227:Adenine Nucleotides / Q000008:administration & dosage; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001087:Arabinonucleosides / Q000008:administration & dosage; D002423:Cause of Death; D000077866:Clofarabine; D003561:Cytarabine / Q000008:administration & dosage; D003630:Daunorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
D000227:Adenine Nucleotides; D001087:Arabinonucleosides; D003561:Cytarabine; D000077866:Clofarabine; D003630:Daunorubicin