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Oral treatment of acute myeloid leukaemia with etoposide, thioguanine, and idarubicin (ETI) in elderly patients: a prospective randomised comparison with intravenous cytarabine, idarubicin, and thioguanine in the second and third treatment cycle
Author(s) -
Ruutu T.,
Koivunen E.,
Nousiainen T.,
Pelliniemi T.T.,
Almqvist A.,
Anttila P.,
Jantunen E.,
Koistinen P.,
Koponen A.,
Mikkola M.,
Oksanen K.,
Pulli T.,
Remes K.,
Sarkkinen R.,
Silvennoinen R.,
Timonen T.,
Vanhatalo S.,
Elonen E.
Publication year - 2004
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1046/j.0902-4441.2003.00182.x
Subject(s) - idarubicin , medicine , cytarabine , etoposide , gastroenterology , surgery , antimetabolite , chemotherapy
A randomised multicentre study was conducted among patients over 65 yr of age with newly diagnosed acute myeloid leukaemia (AML) to compare oral treatment with etoposide 80 mg/m 2 and thioguanine 100 mg/m 2 twice daily on 5 d and idarubicin 15 mg/m 2 on 3 d (ETI) to a mainly i.v. combination of cytarabine 100 mg/m 2 twice daily on 5 d, idarubicin 12 mg/m 2 × 1 , and thioguanine (TAI). Ninety‐two patients were enrolled. Their median age was 72 yr, range 65–84 yr. Sixty‐five patients had de novo AML, 21 AML subsequent to myelodysplastic syndrome, and six treatment‐related AML. They received at first a 6‐d i.v. treatment with cytarabine and idarubicin. After the first treatment, 68 patients were randomised to receive two cycles of ETI ( n = 36) or TAI ( n = 32) and thereafter maintenance with mercaptopurine and methotrexate. Of the 92 patients, 52 (57%) achieved remission at some stage. The median survival was 10 months. There were no significant differences between the patients randomised to ETI or TAI in the remission rate (67% vs. 72%), survival (12 months from randomisation in both arms), event‐free survival or relapse rate. The patients randomised to receive ETI spent significantly fewer days at hospital during the two randomised cycles (20 vs. 41 d, P = 0.010), and they had fewer days with infusions, shorter neutropenias and thrombocytopenias and fewer and less severe infections. In conclusion, treatment with oral ETI resulted in a similar antileukaemic effect as obtained with mainly i.v. TAI, with less toxicity and reduced need for hospitalisation.