Cytosine arabinoside with daunorubicin or adriamycin for therapy of acute myelocytic leukemia: a CALGB study

Abstract

A randomized comparison of the relative efficacy and toxicity of daunorubicin (DNR) at 30 or 45 mg/sq m or adriamycin (ADM) at 30 mg/sq m, given on the first 3 days of a 7-day continuous infusion of cytosine arabinoside (ara-C) at 100 mg/sq m/day, shows the outcome to be dependent on anthracycline, dose, and patient age. DNR 45 is significantly better than DNR 30 or ADM 30 for inducing complete remissions (CR) in patients younger than 60 yr, (72%, 59%, 58% CRs, respectively). DNR 30 is better than DNR 45 or ADM 30 for inducing CR in patients older than 60 yr (47%, 31%, 35%, respectively). There was a corresponding shift in the induction mortality for the age, dose, and anthracycline groups. Adriamycin was significantly more toxic to the gastrointestinal tract than daunorubicin. The duration of complete remission, with cyclic courses of maintenance therapy, was independent of the patient's age, the dose, or choice of anthracycline used in induction, and of whether the maintenance courses were given every 4 wk or every 8 wk.

MDR 1 expression is an independent prognostic factor for response and survival in de novo acute myeloid leukaemia

“…Treatment of acute myeloid leukaemia (AML) with cytosinearabinoside (Ara-C) and daunorubicin results in approximately 65% complete remission in adults (Yates et al, 1982;Cassileth et al, 1992;Mayer et al, 1994;Rees et al, 1986). However, with conventional post-remission chemotherapy, only 25% of these patients remain relapse-free (Yates et al, 1982;Buchner et al, 1985;Vogler et al, 1984).…”

“…Treatment of acute myeloid leukaemia (AML) with cytosinearabinoside (Ara-C) and daunorubicin results in approximately 65% complete remission in adults (Yates et al, 1982;Cassileth et al, 1992;Mayer et al, 1994;Rees et al, 1986). However, with conventional post-remission chemotherapy, only 25% of these patients remain relapse-free (Yates et al, 1982;Buchner et al, 1985;Vogler et al, 1984). Intensive consolidation chemotherapy or myeloablative therapy, followed by allogeneic or autologous stem cell transplantation may overcome minimal residual disease and prevent relapse, resulting in the accomplishment of long-term survival (Mayer et al, 1994;Zittoun et al, 1995;Löwenberg et al, 1990).…”

Contribution of the Nucleoside Transport System to Doxorubicin Transport in HL60 Cells but Not in Mononuclear Cells

“…In clinical leukemia chemotherapy, especially for acute myeloid leukemia, the combination of anthracycline and Ara-C exhibits synergistic antitumor activity. [15][16][17][18] So, there is a discrepancy between the clinical efficacy and our basic results. However, we only examined the uptake of DOX, i.e., we did not assess the uptake of Ara-C or their pharmacological interaction.…”

A randomized phase 2 study of idarubicin and cytarabine with clofarabine or fludarabine in patients with newly diagnosed acute myeloid leukemia

“…The combination of cytarabine and an anthracycline has been the standard induction regimen for patients with acute myeloid leukemia (AML) for >40 years. 1 Several studies have evaluated the addition of a third agent to standard induction chemotherapy. 2 Although many efforts to improve AML therapy have been unsuccessful, the addition of nucleoside analogues to cytarabine-anthracycline regimens has shown promising results.…”