Division of Haematology/Oncology, University Children's Hospital Berne, Berne, Switzerland.
Br J Haematol. 2013 Apr;161(2):192-203. doi: 10.1111/bjh.12233. Epub 2013 Feb 8.
This systematic review and meta-analysis compared the efficacy of different anthracyclines and anthracycline dosing schedules for induction therapy in acute myeloid leukaemia in children and adults younger than 60 years of age. Twenty-nine randomized controlled trials were eligible for inclusion in the review. Idarubicin (IDA), in comparison to daunorubicin (DNR), reduced remission failure rates (risk ratio (RR) 0·81; 95% confidence interval (CI), 0·66-0·99; P = 0·04), but did not alter rates of early death or overall mortality. Superiority of IDA for remission induction was limited to studies with a DNR/IDA dose ratio <5 (ratio <5: RR 0·65; 95% CI, 0·51-0·81; P < 0·001; ratio ≥5: RR 1·03; 95% CI, 0·91-1·16; P = 0·63). Higher-dose DNR, compared to lower-dose DNR, was associated with reduced rates for remission failure (RR 0·75; 95% CI, 0·60-0·94; P = 0·003) and overall mortality (RR 0·83; 95% CI, 0·75-0·93; P < 0·001), but not for early death. Comparisons of several other anthracycline derivates did not reveal significant differences in outcomes. Survival estimates in adults suggest that both high-dose DNR (90 mg/m(2) daily × 3 or 50 mg/m(2) daily × 5) and IDA (12 mg/m(2) daily × 3) can achieve 5-year survival rates of between 40 and 50 percent.
这篇系统评价和荟萃分析比较了不同蒽环类药物和蒽环类药物剂量方案在儿童和 60 岁以下成人急性髓系白血病诱导治疗中的疗效。29 项随机对照试验符合纳入本综述的标准。与柔红霉素（DNR）相比，伊达比星（IDA）降低了缓解失败率（风险比（RR）0.81；95%置信区间（CI），0.66-0.99；P=0.04），但不改变早期死亡率或总死亡率。IDA 诱导缓解的优势仅限于 DNR/IDA 剂量比<5 的研究（比<5：RR 0.65；95%CI，0.51-0.81；P<0.001；比≥5：RR 1.03；95%CI，0.91-1.16；P=0.63）。与低剂量 DNR 相比，高剂量 DNR 与缓解失败率降低相关（RR 0.75；95%CI，0.60-0.94；P=0.003）和总死亡率降低相关（RR 0.83；95%CI，0.75-0.93；P<0.001），但与早期死亡率无关。对几种其他蒽环类衍生物的比较并未显示出结果有显著差异。成人的生存估计表明，高剂量 DNR（90mg/m2 每日×3 或 50mg/m2 每日×5）和 IDA（12mg/m2 每日×3）都可以实现 5 年生存率在 40%至 50%之间。
