Efficacy and safety of induction chemotherapy with daunorubicin or idarubicin in the treatment of an adult with acute lymphoblastic leukemia.

BACKGROUND

Anthracyclines are dispensable components of chemotherapy of patients with acute lymphoblastic leukemia (ALL).

OBJECTIVE

To analyze the efficacy and safety of induction with idarubicin (IDA) or liposoma daunorubicin (L-DNR) in treatment of adults with high-risk ALL (HR-ALL) (presence of mixed lineage leukemia gene [] rearrangements, t[1;19], or prednisone poor response).

METHODS

Among 58 enrolled patients, 29 cases were defined as the IDA group and the other 29 patients were put into the L-DNR group. Both overall survival (OS) and progression-free survival (PFS) were estimated and overall response rate (ORR) was compared between the groups.

RESULTS

The L-DNR group's OS and PFS were insignificantly higher than in the IDA group (=0.261 and =0.247). Although not significantly different, the ORR of adults with HR-ALL receiving L-DNR regimens was also higher than in the IDA group (=0.085). Comprehensive cytogenetic analysis revealed that patients harboring rearrangement, , and mutation had poorer prognosis than others. All 58 patients experienced hematologic response in this study; however, the length of hematologic response in the IDA group was significantly longer than in the L-DNR group (=0.005). The incidence of bleeding and infection was without significant difference between the groups (both >0.05).

CONCLUSION

L-DNR proved to be an effective drug within a multiagent approach, which shows a favorable overall profile, as well as similar adverse events when compared with IDA in HR-ALL. Patients with are much more sensitive to L-DNR than IDA. Despite some progress made, outcomes in rearrangement or mutation carriers remain unsatisfactory, and intensive treatment will be critical.