Potential for improved survival with intensification of daunorubicin based induction chemotherapy in acute myeloid leukemia patients who do not receive transplant: A multicenter retrospective study

• DNR based induction chemotherapy dose intensification improved OS in non-transplanted AML patients.
• No OS benefit for induction chemotherapy intensification was observed in transplanted AML patients.
• Induction chemotherapy intensification should be considered for all fit younger AML patients.

IntroductionDuring induction daunorubicin intensification from 45 mg/m2/day to 90 mg/m2/day has shown improved response and survival rates in AML patients. We retrospectively reviewed outcomes of daunorubicin 60 mg/m2/day (DNR60) versus daunorubicin 90 mg/m2/day (DNR90) in adult AML patients.Material and methodsNewly diagnosed AML patients ≥18 years who received 7 + 3 with or without etoposide as frontline therapy from 1/1/2006 to 5/1/2013 were identified. Chi-square and Wilcoxon rank sum tests were used to compare characteristics. Kaplan–Meier curves were estimated for overall survival (OS). Univariate and multivariate Cox proportional hazard regression models were developed to determine independent predictors for survival.ResultsA total of 128 patients were included (DNR90 = 48 patients, DNR60 = 80 patients). The estimated 3-year OS rate in the DNR90 group was 56% (95% CI 38–70%), while in the DNR60 group was 34% (95% CI 23–44%). Multivariate analysis (MVA) in non-allotransplanted patients showed that unfavorable cytogenetics and worse performance status were associated with decreased OS while DNR intensification, etoposide use and site were associated with improved OS. In MVA of allotransplanted patients re-induction based on day-14 marrow was associated with worse OS.ConclusionsBased on our retrospective study, initial DNR based induction chemotherapy intensification improved OS in non-allotransplanted patients. Prospective studies are needed to confirm this preliminary finding.