Comparison Of DA And IA Protocol In Treatment Of Newly Diagnosed Acute Myeloid Leukemia In Adults

【Background】Acute myeloid leukemia(AML) is a highly heterogeneous hematologic malignancies whichbone marrow hematopoietic progenitor cells proliferate abnormally with poorprognosis.Conventional induction "3+7" with the combination of anthracycline andcytarabine is still the standard of care in AML currently.Simultaneously supportive careincluding blood component transfusion,widespread use of antibiotics has improved theprognosis of AML. Overseas studies have shown complete remission rate is about65%-85%,and5-year OS rate is approximately40%-50%. Idarubicin and daunorubicin areanthracyclines which have been widely used in the induction therapy of acute myeloidleukemia, but differences in the efficacy of the two protocol are no clear conclusion athome and abroad.【Objective】To investigate the efficacy and toxicity of either idarubicin or daunorubicin in combinationwith cytarabine as induction therapy in adult patients with newly diagnosed non M3-AML.【Methods】Retrospectively analyzing the clinical data of157adult patients with de novo AML whichwere diagnosed from May1,2005to November30,2011in Fujian Medical UniversityUnion Hospital.106patients were treated with IA remission-induction protocol（idarubicin[8to10mg/m~2daily,days1to3],cytarabine [200mg/m~2daily, days1to7]）,and51patients received DA protoco（ldaunorubicin [40to45mg/m~2daily，days1to3],cytarabine[200mg/m~2daily,days1to7]）.Efficacy and toxicity analysis were compared between thetwo groups.【Results】After up to two courses,70(76.9%) of91patients achieved complete remission in the idarubicin group and25(59.5%) of42in the daunorubicin group (P=0.039).Completeremission rate of IA group was higher than that of DA group in the moderate cytogeneticprognostic group.In the IA group,complete remission rate in patients with poor cytogeneticprognostic was lower than that in patients with good and moderate cytogeneticprognostic.But no similar result was found in the DA group. The median overall survivalwere respectively13.97(1.3-82.7) months in the IA group and7.7(1.7-66) months in theDA group, overall survival rates at3years were71.1%and34.7%, medianrelapse-freesurvival were13.0(1.1-80.9)months and9.0(1.2-27.2) months, the differencewas significant (P<0.05). Myelosuppression, infection, nausea and vomiting were the mostfrequent adverse effects in two groups.【Conclusion】IA protocol has a higher CR rate, longer OS than DA for the treatment of newly diagnosednon M3-AML, and the two groups have no significant difference between toxicity. It isconsidered that idarubicin has a better efficacy compared with daunorubicin,and also is currently first-line anti-leukemia drug with reliable efficacy and well-tolerance.