Efficacy of conventional-dose cytarabine, idarubicin and thioguanine versus intermediate-dose cytarabine and idarubicin in the induction treatment of acute myeloid leukemia: Long-term results of the prospective randomized nationwide AML-2003 study by the Finnish Leukemia Group

Aarne Kolonen*, Marjatta Sinisalo, Heini Huhtala, Johanna Rimpiläinen, Hannele Rintala, Marja Sankelo, Elli Koivunen, Raija Silvennoinen, Riikka Räty, Tapani Ruutu, Liisa Volin, Kimmo Porkka, Esa Jantunen, Tapio Nousiainen, Taru Kuittinen, Karri Penttilä, Marja Pyörälä, Marjaana Säily, Pirjo Koistinen, Marjut KauppilaMaija Itälä-Remes, Hanna Ollikainen, Auvo Rauhala, Veli Kairisto, Tarja-Terttu Pelliniemi, Erkki Elonen

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objectives
To compare the long-term efficacy and safety of two randomized induction treatments (IAT vs. IdAraC-Ida) in AML patients and introduce the results of a novel risk grouping and residual disease guided treatment strategy.
Methods
Structured questionnaire forms were used to gather data in each cycle of treatment and during follow-up. SPSS version 25 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis.
Results
356 patients with AML participated in the study. Long term overall survival (OS) and relapse-free survival (RFS) observed in our study were 49 % and 49 % at 10 years, respectively. Median follow-up for the living patients was 114 months. No significant difference in remission induction rate, OS, RFS was observed between the two induction treatments. Risk classification according to protocol, measurable residual disease (MRD) status after first consolidation treatment (P < 0.001) and last consolidation treatment (P < 0.001) affected the overall survival and relapse-free survival.
Conclusions
Intensified cytarabine dose in first induction treatment is unlikely to yield favorable long-term results compared with IAT in patients with AML. Intensified post-remission treatment in patients with clinical risk factors or MRD seems reasonable, but randomized controlled studies are warranted in the future.
Translated title of the contributionEffekten av konventionella doser cytarabin, idarubicin och tioguanin (IAT) kontra mellandos cytarabin och idarubicin (IdAraC-Ida) vid induktionsbehandling av AML och effekterna av kvarvarande sjukdom: långsiktiga resultat av den potentiella randomiserade rikstäckande AML- 2003 studie av den finska leukemigruppen
Original languageEnglish
Pages (from-to)257-270
JournalEuropean Journal of Haematology
Volume109
Issue number3
DOIs
Publication statusPublished - 30 May 2022
MoE publication typeA1 Journal article-refereed

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