Potential Methods for Intensifying Induction Therapy for AML
| Strategy . | Comments . | Potential Studies . |
|---|---|---|
| I.Modulation of anthracycline | ||
| Substitution for daunorubicin (DNR) | ||
| 1.Idarubicin (IDA) | More effective (cf DNR 45 mg/m2)24-26 | Phase III studies of DNR v IDA v MITO in progress |
| 2.Amsacrine | Probably more effective (cf DNR 50 mg/m2)20 | |
| 3.Aclarubicin | Probably more effective (cf DNR 45 mg/m2)22 | |
| 4.Mitoxantrone (MITO) | Possibly more effective (cf DNR 45 mg/m2)15 | |
| Increasing dose of anthracycline | ||
| 1.Daunorubicin | Not yet studied in a prospective comparison. | 45 mg/m2 → 60-90 mg/mg2 |
| 2.Idarubicin | Not yet studied in a prospective comparison. | 12 mg/m2 → 15-20 mg/m2 |
| II.Modulation of cytosine arabinoside | ||
| Increasing standard dose (100 → 200 → 500 mg/m2) | No improvement9,11,44 45 | |
| Increasing standard duration (7 → 10 days) | Modest gains at best9 44 | |
| High dose (HDAC) (1.5-3.0 g/m2 × 6-12 doses) | No effect on CR. Prolongs DFS.33 54 | |
| III.Addition of etoposide | No effect on CR. Prolongs DFS.55 | |
| IV.Addition of HDAC after standard 3 + 7 | Promising phase II data.57 | Phase III studies (cf standard 3 + 7) encouraged. |
| V.Timed sequential therapy (day 6-10) | No effect on CR. Prolongs DFS.50,59,61 67 | |
| VI.Very early intensification (day 10-21) with repeat induction or similar | No effect on CR. Prolongs DFS (childhood AML)68 (TAD-TAD/HAM at day 21).69 | Repeat standard induction (eg, 3 + 7) at day 10-14, in adults, not yet studied |
| Strategy . | Comments . | Potential Studies . |
|---|---|---|
| I.Modulation of anthracycline | ||
| Substitution for daunorubicin (DNR) | ||
| 1.Idarubicin (IDA) | More effective (cf DNR 45 mg/m2)24-26 | Phase III studies of DNR v IDA v MITO in progress |
| 2.Amsacrine | Probably more effective (cf DNR 50 mg/m2)20 | |
| 3.Aclarubicin | Probably more effective (cf DNR 45 mg/m2)22 | |
| 4.Mitoxantrone (MITO) | Possibly more effective (cf DNR 45 mg/m2)15 | |
| Increasing dose of anthracycline | ||
| 1.Daunorubicin | Not yet studied in a prospective comparison. | 45 mg/m2 → 60-90 mg/mg2 |
| 2.Idarubicin | Not yet studied in a prospective comparison. | 12 mg/m2 → 15-20 mg/m2 |
| II.Modulation of cytosine arabinoside | ||
| Increasing standard dose (100 → 200 → 500 mg/m2) | No improvement9,11,44 45 | |
| Increasing standard duration (7 → 10 days) | Modest gains at best9 44 | |
| High dose (HDAC) (1.5-3.0 g/m2 × 6-12 doses) | No effect on CR. Prolongs DFS.33 54 | |
| III.Addition of etoposide | No effect on CR. Prolongs DFS.55 | |
| IV.Addition of HDAC after standard 3 + 7 | Promising phase II data.57 | Phase III studies (cf standard 3 + 7) encouraged. |
| V.Timed sequential therapy (day 6-10) | No effect on CR. Prolongs DFS.50,59,61 67 | |
| VI.Very early intensification (day 10-21) with repeat induction or similar | No effect on CR. Prolongs DFS (childhood AML)68 (TAD-TAD/HAM at day 21).69 | Repeat standard induction (eg, 3 + 7) at day 10-14, in adults, not yet studied |