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Keywords:

  • acute myeloid leukaemia;
  • anthracyclines;
  • treatment;
  • toxicity

Summary

This systematic review and meta-analysis compared the efficacy of different anthracyclines and anthracycline dosing schedules for induction therapy in acute myeloid leukaemia in children and adults younger than 60 years of age. Twenty-nine randomized controlled trials were eligible for inclusion in the review. Idarubicin (IDA), in comparison to daunorubicin (DNR), reduced remission failure rates (risk ratio (RR) 0·81; 95% confidence interval (CI), 0·66–0·99; = 0·04), but did not alter rates of early death or overall mortality. Superiority of IDA for remission induction was limited to studies with a DNR/IDA dose ratio <5 (ratio <5: RR 0·65; 95% CI, 0·51–0·81; < 0·001; ratio ≥5: RR 1·03; 95% CI, 0·91–1·16; = 0·63). Higher-dose DNR, compared to lower-dose DNR, was associated with reduced rates for remission failure (RR 0·75; 95% CI, 0·60–0·94; = 0·003) and overall mortality (RR 0·83; 95% CI, 0·75–0·93; < 0·001), but not for early death. Comparisons of several other anthracycline derivates did not reveal significant differences in outcomes. Survival estimates in adults suggest that both high-dose DNR (90 mg/m2 daily × 3 or 50 mg/m2 daily × 5) and IDA (12 mg/m2 daily × 3) can achieve 5-year survival rates of between 40 and 50 percent.