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Acute Leukemias

Escalation of daunorubicin and addition of etoposide in the ADE regimen in acute myeloid leukemia patients aged 60 years and older: Cancer and Leukemia Group B Study 9720

Leukemia volume 25, pages 800–807 (2011)Cite this article

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Abstract

Untreated de novo (n=421) and secondary (n=189) acute myeloid leukemia (AML) patients ⩾60 years received intensified chemotherapy, including daunorubicin 60 mg/m2 and etoposide 100 mg/m2 during days 1, 2, 3 with cytarabine 100 mg/m2 during days 1–7, with a second induction if needed and one consolidation course with these drugs and doses for 2, 2 and 5 days, respectively. In all, 287 (47%) achieved complete remission (CR), 136 (22%) died and 187 (31%) were non-responders. CR rates were 27, 44 and 52% for complex karyotypes, rare aberrations and neither (P<0.001), 52 and 37% for de novo and secondary AML (P=0.003), and 53 and 42% for age 60–69 and ⩾70 years (P=0.015). In multivariable analysis, CR predictors included non-complex/non-rare karyotypes (P<0.001), de novo AML (P<0.001), better performance status (PS) (P<0.001) and younger age (P=0.001). Disease-free (DFS) and overall (OS) survival medians were 6.8 (95% CI: 6.2, 7.8) and 7.2 (95% CI: 6.4, 8.6) months. In multivariable analysis, DFS was shorter for complex karyotypes (P<0.001) and increasing white blood count (WBC) (P<0.001) and age (P=0.038), and OS for complex karyotypes (P<0.001), increasing WBC (P=0.001) and age (P<0.001), poorer PS (P<0.001) and secondary AML (P=0.010). Outcomes and prognostic factors were similar to those in previous Cancer and Leukemia Group B studies.

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Acknowledgements

The research for CALGB 9720 was supported, in part, by grants from the National Cancer Institute (CA31946) to the Cancer and Leukemia Group B (Richard L. Schilsky, MD, Chairman) and to the CALGB Statistical Center (Stephen George, PhD, CA33601), and by grants CA31983 and CA02599 (to MRB), CA33601 (to SLG and BLS), CA77658, 101140 and grants from the Coleman Leukemia Research Foundation (to KM, MAC, CDB), CA35279 (to JEK), CA47577 (to JOM), CA32291 (to RMS), CA03927 (to BLP) and CA41287 (to RAL). The authors thank the many patients, treating physicians, nurses and CALGB clinical research associates who participated in this study, and also thank CALGB Protocol Coordinator Michael Kelly for his assistance.

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Authors and Affiliations

  1. University of Maryland Department of Medicine and Greenebaum Cancer Center, Baltimore, MD, USA

    M R Baer

  2. Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA

    M R Baer

  3. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    S L George

  4. CALGB Statistical Center, Duke University Medical Center, Durham, NC, USA

    S L George & B L Sanford

  5. The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    K Mrózek, M A Caligiuri & C D Bloomfield

  6. Division of Hematology/Oncology, Monter Cancer Center, Hofstra North Shore-LIJ School of Medicine, Manhasset, NY, USA

    J E Kolitz

  7. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    J O Moore

  8. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    R M Stone

  9. Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA

    B L Powell

  10. Department of Medicine, University of Chicago, Chicago, IL, USA

    R A Larson

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This work was presented in part at the American Society of Hematology 2007 Annual Meeting.

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A list of CALGB institutions that participated in this study and principal investigators is provided in the Supplementary Information.

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Baer, M., George, S., Sanford, B. et al. Escalation of daunorubicin and addition of etoposide in the ADE regimen in acute myeloid leukemia patients aged 60 years and older: Cancer and Leukemia Group B Study 9720. Leukemia 25, 800–807 (2011). https://doi.org/10.1038/leu.2011.9

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