High-dose cytarabine (24g/m2) in combination with idarubicin (HiDAC-3) results in high first-cycle response with limited gastrointestinal toxicity in adult acute myeloid leukaemia

M Low, D Lee, John Coutsouvelis, Sushrut Patil, Stephen Opat, Patricia Ann Walker, Anthony Schwarer, Hatem Hassan Salem, Sharon Avery, Andrew Spencer, Andrew Wei

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background/Aim: Although induction chemotherapy comprising high-dose cytarabine (HiDAC) in combination with idarubicin and etoposide or ICE for adult acute myeloid leukaemia (AML) produces a complete remission rate of nearly 80 , gastrointestinal toxicity is significant. Omission of etoposide may produce similar clinical outcomes with potentially less gastrointestinal toxicity. Methods: Fifty-three consecutive patients aged 15-60 with newly diagnosed AML, receiving high-dose cytarabine induction at the Alfred Hospital, Melbourne, were retrospectively analysed. Regimens included HiDAC-3 (idarubicin 12mg/m2 day 1-3, cytarabine 3gm/m2 bd day 1,3,5,7) or ICE (idarubicin 9mg/m2 day 1-3, cytarabine 3g/m2 bd day 1,3,5,7, etoposide 75mg/m2 day 1-7). Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.03. Results: Thirty-one patients received HIDAC-3 and 22 patients received ICE induction. HiDAC-3 was better tolerated than ICE in terms of lower frequency of grade 3-4 nausea (0 vs 41 ; P <0.01), grade 3-4 diarrhoea (26 vs 55 ; P = 0.05), lower rates of radiologically evident enterocolitis (6 vs 32 ; P = 0.03) and less cumulative days of total parenteral nutrition use (1.2 vs 7.3 days; P <0.01). Times to haematological recovery were similar between the two regimens. Thirty-day mortality was 0 for HiDAC-3 and 9 for ICE. Eighty-four per cent of HiDAC-3-treated patients achieved complete remission after the first cycle of therapy, compared with 77 with ICE. No differences in survival were evident between the two regimens. Conclusions: HiDAC-3 is a clinically effective induction regimen for adult AML, producing a high rate of first-cycle complete remission with less treatment-related gastrointestinal toxicity than ICE. ? 2012 Royal Australasian College of Physicians.
Original languageEnglish
Pages (from-to)294 - 297
Number of pages4
JournalInternal Medicine Journal
Volume43
Issue number3
DOIs
Publication statusPublished - 2013

Cite this

@article{b5357923509540269f5aed43f61b72b8,
title = "High-dose cytarabine (24g/m2) in combination with idarubicin (HiDAC-3) results in high first-cycle response with limited gastrointestinal toxicity in adult acute myeloid leukaemia",
abstract = "Background/Aim: Although induction chemotherapy comprising high-dose cytarabine (HiDAC) in combination with idarubicin and etoposide or ICE for adult acute myeloid leukaemia (AML) produces a complete remission rate of nearly 80 , gastrointestinal toxicity is significant. Omission of etoposide may produce similar clinical outcomes with potentially less gastrointestinal toxicity. Methods: Fifty-three consecutive patients aged 15-60 with newly diagnosed AML, receiving high-dose cytarabine induction at the Alfred Hospital, Melbourne, were retrospectively analysed. Regimens included HiDAC-3 (idarubicin 12mg/m2 day 1-3, cytarabine 3gm/m2 bd day 1,3,5,7) or ICE (idarubicin 9mg/m2 day 1-3, cytarabine 3g/m2 bd day 1,3,5,7, etoposide 75mg/m2 day 1-7). Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.03. Results: Thirty-one patients received HIDAC-3 and 22 patients received ICE induction. HiDAC-3 was better tolerated than ICE in terms of lower frequency of grade 3-4 nausea (0 vs 41 ; P <0.01), grade 3-4 diarrhoea (26 vs 55 ; P = 0.05), lower rates of radiologically evident enterocolitis (6 vs 32 ; P = 0.03) and less cumulative days of total parenteral nutrition use (1.2 vs 7.3 days; P <0.01). Times to haematological recovery were similar between the two regimens. Thirty-day mortality was 0 for HiDAC-3 and 9 for ICE. Eighty-four per cent of HiDAC-3-treated patients achieved complete remission after the first cycle of therapy, compared with 77 with ICE. No differences in survival were evident between the two regimens. Conclusions: HiDAC-3 is a clinically effective induction regimen for adult AML, producing a high rate of first-cycle complete remission with less treatment-related gastrointestinal toxicity than ICE. ? 2012 Royal Australasian College of Physicians.",
author = "M Low and D Lee and John Coutsouvelis and Sushrut Patil and Stephen Opat and Walker, {Patricia Ann} and Anthony Schwarer and Salem, {Hatem Hassan} and Sharon Avery and Andrew Spencer and Andrew Wei",
year = "2013",
doi = "10.1111/j.1445-5994.2012.02868.x",
language = "English",
volume = "43",
pages = "294 -- 297",
journal = "Internal Medicine Journal",
issn = "1444-0903",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - High-dose cytarabine (24g/m2) in combination with idarubicin (HiDAC-3) results in high first-cycle response with limited gastrointestinal toxicity in adult acute myeloid leukaemia

AU - Low, M

AU - Lee, D

AU - Coutsouvelis, John

AU - Patil, Sushrut

AU - Opat, Stephen

AU - Walker, Patricia Ann

AU - Schwarer, Anthony

AU - Salem, Hatem Hassan

AU - Avery, Sharon

AU - Spencer, Andrew

AU - Wei, Andrew

PY - 2013

Y1 - 2013

N2 - Background/Aim: Although induction chemotherapy comprising high-dose cytarabine (HiDAC) in combination with idarubicin and etoposide or ICE for adult acute myeloid leukaemia (AML) produces a complete remission rate of nearly 80 , gastrointestinal toxicity is significant. Omission of etoposide may produce similar clinical outcomes with potentially less gastrointestinal toxicity. Methods: Fifty-three consecutive patients aged 15-60 with newly diagnosed AML, receiving high-dose cytarabine induction at the Alfred Hospital, Melbourne, were retrospectively analysed. Regimens included HiDAC-3 (idarubicin 12mg/m2 day 1-3, cytarabine 3gm/m2 bd day 1,3,5,7) or ICE (idarubicin 9mg/m2 day 1-3, cytarabine 3g/m2 bd day 1,3,5,7, etoposide 75mg/m2 day 1-7). Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.03. Results: Thirty-one patients received HIDAC-3 and 22 patients received ICE induction. HiDAC-3 was better tolerated than ICE in terms of lower frequency of grade 3-4 nausea (0 vs 41 ; P <0.01), grade 3-4 diarrhoea (26 vs 55 ; P = 0.05), lower rates of radiologically evident enterocolitis (6 vs 32 ; P = 0.03) and less cumulative days of total parenteral nutrition use (1.2 vs 7.3 days; P <0.01). Times to haematological recovery were similar between the two regimens. Thirty-day mortality was 0 for HiDAC-3 and 9 for ICE. Eighty-four per cent of HiDAC-3-treated patients achieved complete remission after the first cycle of therapy, compared with 77 with ICE. No differences in survival were evident between the two regimens. Conclusions: HiDAC-3 is a clinically effective induction regimen for adult AML, producing a high rate of first-cycle complete remission with less treatment-related gastrointestinal toxicity than ICE. ? 2012 Royal Australasian College of Physicians.

AB - Background/Aim: Although induction chemotherapy comprising high-dose cytarabine (HiDAC) in combination with idarubicin and etoposide or ICE for adult acute myeloid leukaemia (AML) produces a complete remission rate of nearly 80 , gastrointestinal toxicity is significant. Omission of etoposide may produce similar clinical outcomes with potentially less gastrointestinal toxicity. Methods: Fifty-three consecutive patients aged 15-60 with newly diagnosed AML, receiving high-dose cytarabine induction at the Alfred Hospital, Melbourne, were retrospectively analysed. Regimens included HiDAC-3 (idarubicin 12mg/m2 day 1-3, cytarabine 3gm/m2 bd day 1,3,5,7) or ICE (idarubicin 9mg/m2 day 1-3, cytarabine 3g/m2 bd day 1,3,5,7, etoposide 75mg/m2 day 1-7). Toxicity was assessed using Common Terminology Criteria for Adverse Events version 4.03. Results: Thirty-one patients received HIDAC-3 and 22 patients received ICE induction. HiDAC-3 was better tolerated than ICE in terms of lower frequency of grade 3-4 nausea (0 vs 41 ; P <0.01), grade 3-4 diarrhoea (26 vs 55 ; P = 0.05), lower rates of radiologically evident enterocolitis (6 vs 32 ; P = 0.03) and less cumulative days of total parenteral nutrition use (1.2 vs 7.3 days; P <0.01). Times to haematological recovery were similar between the two regimens. Thirty-day mortality was 0 for HiDAC-3 and 9 for ICE. Eighty-four per cent of HiDAC-3-treated patients achieved complete remission after the first cycle of therapy, compared with 77 with ICE. No differences in survival were evident between the two regimens. Conclusions: HiDAC-3 is a clinically effective induction regimen for adult AML, producing a high rate of first-cycle complete remission with less treatment-related gastrointestinal toxicity than ICE. ? 2012 Royal Australasian College of Physicians.

UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2012.02868.x/pdf

U2 - 10.1111/j.1445-5994.2012.02868.x

DO - 10.1111/j.1445-5994.2012.02868.x

M3 - Article

VL - 43

SP - 294

EP - 297

JO - Internal Medicine Journal

JF - Internal Medicine Journal

SN - 1444-0903

IS - 3

ER -