Daunorubicin Versus Mitoxantrone Versus Idarubicin As Induction and Consolidation Chemotherapy for Adults With Acute Myeloid Leukemia: The EORTC and GIMEMA Groups Study AML-10
Daunorubicin Versus Mitoxantrone Versus Idarubicin As Induction and Consolidation Chemotherapy for Adults With Acute Myeloid Leukemia: The EORTC and GIMEMA Groups Study AML-10
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DOI：
10.1200/jco.2008.20.6490
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发表时间：
2009-11-10
影响因子：
45.3
通讯作者：
de Witte, Theo
中科院分区：
文献类型：
--
作者：
Mandelli, Franco;Vignetti, Marco;de Witte, Theo
目的比较三种蒽环类药物联合阿糖胞苷和依托泊苷治疗成人新诊断急性髓性白血病（AML）的抗肿瘤疗效。患者和方法我们随机分配2157例患者（年龄范围，15 - 60岁）接受含柔红霉素、依甲红霉素或米托蒽醌的强化诱导巩固化疗。在达到完全缓解（CR）后，患者被分配接受同种异体或自体干细胞移植（SCT），这取决于是否有兄弟姐妹供体。结果三组患者的总CR率（69%）相近。柔红霉素组37%的患者进行了自体SCT，而米托蒽醌和去甲红霉素组分别只有29%和31% （P < 0.001）。然而，柔红霉素组的无病生存期（DFS）和CR生存期明显较短：5年DFS分别为29%，米托蒽醌组为37%，柔红霉素组为37%。在三个治疗组中，接受同种异体SCT的患者比例（22%）相同，结果也相似：5年总生存率分别为34%、34%和31%。结论在未接受同种异体SCT的成年AML患者中，使用米托蒽醌或伊达红霉素代替柔红霉素可提高化疗的长期疗效。
PurposeTo compare the antitumor efficacy of three different anthracyclines in combination with cytarabine and etoposide in adult patients with newly diagnosed acute myeloid leukemia (AML).Patients and MethodsWe randomly assigned 2,157 patients ( age range, 15 to 60 years) to receive intensive induction-consolidation chemotherapy containing either daunorubicin, idarubicin, or mitoxantrone. After achieving complete remission (CR), patients were assigned to undergo either allogeneic or autologous stem-cell transplantation (SCT), depending on the availability of a sibling donor.ResultsThe overall CR rate (69%) was similar in the three groups. Autologous SCT was performed in 37% of cases in the daunorubicin arm versus only 29% and 31% in mitoxantrone and idarubicin, respectively (P < .001). However, the disease-free survival (DFS) and survival from CR were significantly shorter in the daunorubicin arm: the 5-year DFS was 29% versus 37% and 37% in mitoxantrone and idarubicin, respectively. The proportion of patients who underwent allogeneic SCT (22%) was equivalent in the three treatment groups, and the outcome was similar as well: the 5-year overall survival rates were 34%, 34%, and 31%, respectively.ConclusionIn adult patients with AML who do not receive an allogeneic SCT, the use of mitoxantrone or idarubicin instead of daunorubicin enhances the long-term efficacy of chemotherapy.