What is the efficacy of cytarabine combination 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

A study by Liu et al in 74 patients older than 60 years with newly diagnosed non-M3 AML reported a significantly higher complete remission rate with reduced-intensity idarubicin plus cytarabine than with daunorubicin plus cytarabine (70.4% vs 40%, P = 0.028). The difference was especially marked in patients with white blood cell (WBC) counts >10 × 109/L (P = 0.042) and ECOG (Eastern Cooperative Oncology Group) score 45</ref>

Alternatively, high-dose cytarabine combined with idarubicin, daunorubicin, or mitoxantrone can be used as induction therapy in younger patients. The use of high-dose cytarabine outside the setting of a clinical trial is considered controversial. However, 2 studies demonstrated improved disease-free survival rates in younger patients who received high-dose cytarabine during induction.

A study of dosing regimens for cytarabine induction therapy determined that lower doses produce maximal antileukemic effects for all response end points. [46] Thus, high-dose cytarabine results in excessive toxic effects with no therapeutic advantage.


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