A comparison of clofarabine with ara-C, each in combination with daunorubicin as induction treatment in older patients with acute myeloid leukaemia

Burnett, Alan Kenneth, Russell, N. H., Hills, Robert Kerrin ORCID: https://orcid.org/0000-0003-0166-0062, Kell, J., Nielsen, O. J., Dennis, M., Cahalin, P., Pocock, C., Ali, S., Burns, Sarah, Freeman, S., Milligan, D. and Clark, R. E. 2017. A comparison of clofarabine with ara-C, each in combination with daunorubicin as induction treatment in older patients with acute myeloid leukaemia. Leukemia 31 (2) , pp. 310-317. 10.1038/leu.2016.225

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Abstract

The study was designed to compare clofarabine plus daunorubicin vs daunorubicin/ara-C in older patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS). Eight hundred and six untreated patients in the UK NCRI AML16 trial with AML/high-risk MDS (median age, 67 years; range 56–84) and normal serum creatinine were randomised to two courses of induction chemotherapy with either daunorubicin/ara-C (DA) or daunorubicin/clofarabine (DClo). Patients were also included in additional randomisations; ± one dose of gemtuzumab ozogamicin in course 1; 2v3 courses and ± azacitidine maintenance. The primary end point was overall survival. The overall response rate was 69% (complete remission (CR) 60% CRi 9%), with no difference between DA (71%) and DClo (66%). There was no difference in 30-/60-day mortality or toxicity: significantly more supportive care was required in the DA arm even though platelet and neutrophil recovery was significantly slower with DClo. There were no differences in cumulative incidence of relapse (74% vs 68% hazard ratio (HR) 0.93 (0.77–1.14), P=0.5); survival from relapse (7% vs 9% HR 0.96 (0.77–1.19), P=0.7); relapse-free (31% vs 32% HR 1.02 (0.83–1.24), P=0.9) or overall survival (23% vs 22% HR 1.08 (0.93–1.26), P=0.3). Clofarabine 20 mg/m2 given for 5 days with daunorubicin is not superior to ara-C+daunorubicin as induction for older patients with AML/high-risk MDS.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This work is licensed under a Creative Commons Attribution 4.0 International License
ISSN:	0887-6924
Date of First Compliant Deposit:	11 July 2019
Date of Acceptance:	12 July 2016
Last Modified:	20 Jan 2024 14:48
URI:	https://orca.cardiff.ac.uk/id/eprint/101807

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