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Blood. 2015 Jun 18;125(25):3878-85. doi: 10.1182/blood-2015-01-623447. Epub 2015 Apr 1.

A randomized comparison of daunorubicin 90 mg/m2 vs 60 mg/m2 in AML induction: results from the UK NCRI AML17 trial in 1206 patients.

Author information

  • 1Department of Haematology, Cardiff University School of Medicine, Cardiff, United Kingdom;
  • 2Department of Haematology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom;
  • 3Department of Haematology, University Hospital of Wales Cardiff, United Kingdom;
  • 4Department of Haematology, St Bartholomew's Hospital, West Smithfield, London United Kingdom;
  • 5Department of Haematology, Rigshospitalet, Copenhagen, Denmark;
  • 6Department of Haematology, Belfast City Hospital, Belfast, United Kingdom;
  • 7Blackpool Victoria Hospital, Blackpool, United Kingdom;
  • 8Department of Haematology, Christie Hospital, Manchester, United Kingdom;
  • 9Department of Haematology, University of Odense, Odense, Denmark;
  • 10Department of Haematology, Heartlands Hospital, Birmingham, United Kingdom; and.
  • 11Department of Haematology, Royal Liverpool University Hospital, Liverpool, United Kingdom.


Modifying induction therapy in acute myeloid leukemia (AML) may improve the remission rate and reduce the risk of relapse, thereby improving survival. Escalation of the daunorubicin dose to 90 mg/m(2) has shown benefit for some patient subgroups when compared with a dose of 45 mg/m(2), and has been recommended as a standard of care. However, 60 mg/m(2) is widely used and has never been directly compared with 90 mg/m(2). As part of the UK National Cancer Research Institute (NCRI) AML17 trial, 1206 adults with untreated AML or high-risk myelodysplastic syndrome, mostly younger than 60 years of age, were randomized to a first-induction course of chemotherapy, which delivered either 90 mg/m(2) or 60 mg/m(2) on days 1, 3, and 5 combined with cytosine arabinoside. All patients then received a second course that included daunorubicin 50 mg/m(2) on days 1, 3, and 5. There was no overall difference in complete remission rate (73% vs 75%; odds ratio, 1.07 [0.83-1.39]; P = .6) or in any recognized subgroup. The 60-day mortality was increased in the 90 mg/m(2) arm (10% vs 5% (hazard ratio [HR] 1.98 [1.30-3.02]; P = .001), which resulted in no difference in overall 2-year survival (59% vs 60%; HR, 1.16 [0.95-1.43]; P = .15). In an exploratory subgroup analysis, there was no subgroup that showed significant benefit, although there was a significant interaction by FLT3 ITD mutation. This trial is registered at as #ISRCTN55675535.

© 2015 by The American Society of Hematology.

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