What is the efficacy of daunorubicin induction regimens for the treatment of acute myeloid leukemia (AML)?

Updated: May 26, 2020
  • Author: Karen Seiter, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Improved outcomes have been reported with induction regimens using a higher dose of daunorubicin (90 mg/m2/d for 3 d compared with 45 mg/m2/d). In a study by Fernandez et al in 657 patients younger than 60 years with untreated AML, the complete remission rate with high-dose daunorubicin was 70.6%, versus 57.3% with conventional-dose daunorubicin, and overall survival was a median of 23.7 versus 15.7 months, respectively. [42]

In a similar study in 813 patients 60 years of age or older by Lowenberg et al, the complete remission rate was 64% in the escalated-dose group compared with 54% in conventional-dose group. In both groups, daunorubicin was administered over 3 hours on days 1-3. Cytarabine was given in a dose of 200 mg/m2/d as a continuous infusion for 7 days, followed by a second cycle at a dose of 1000 mg/m2/12 h for 6 days. [43]

No significant difference was seen between the groups in terms of hematologic toxic effects, 30-day mortality, or other significant adverse events. Although survival endpoints did not differ between the two groups overall, in patients aged 60-65 years the complete remission rate, event-free survival, and overall survival were superior in the escalated-dose group. [43]

A study comparing daunorubicin 90 mg/m2 versus 60 mg/m2 for AML induction found no difference in complete remission rate (73% versus 75%) or in 2-year overall survival (59% versus 60%). [44]


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