Various acceptable induction regimenfor AML are available. The most common approach is called ”3 and 7,” which consists of 3 days of a 15- to 30-minute infusion of an anthracycline (idarubicin or daunorubicin) or anthracenedione (mitoxantrone), combined with 100 mg/m2 of arabinosylcytosine (araC) as a 24-hour infusion daily for 7 days. Idarubicin is given at a dose of 12 mg/m2/d for 3 days, daunorubicin at 45-60 mg/m2/d for 3 days, or mitoxantrone at 12 mg/m2/d for 3 days. Using these regimens, approximately 50% of patients achieve remission with one course. Another 10-15% enter remission following a second course of therapy. Alternatively, high-dose araC combined with idarubicin, daunorubicin, or mitoxantrone can be used as induction therapy in younger patients.
Etoposide as a single agent is active in relapsed and refractory acute myelogenous leukemia (AML), with complete response (CR) rates of 10% to 25%. The drug has been safely combined with cytarabine, azacytidine, vinca alkaloids, and anthracyclines, inducing remission rates of 20% to 60% in patients with previously treated AML.In 1990, the Australian Leukemia Study Group assessed a standard regimen of cytarabine and daunorubicin and the same regimen combined with etoposide. Complete response rates were similar in the two treatment groups, but the triple-drug regimen yielded statistically significantly better disease-free and overall survival among patients <55 years of age. Statistically significant differences in outcome for this age group have persisted; however, no significant outcome differences were observed among older patients.The combination of cytarabine, mitoxantrone and etoposide is popular in Europe, as induction therapy for patients with relapsed or refractory AML. No prospective, comparative trials show this regimen to be superior to other regimens in the same setting. The field has moved onto newer agents and more intensive consolidation therapy. The use of etoposide should not be considered investigational, however, since it is supported by a randomized study.
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