Cladribine Plus Idarubicin/Cytarabine Induction for Untreated Acute Myeloid Leukemia

Mark J. Fesler, MD, Camille Adeimy, MD* and Paul J. Petruska, MD

Author address: 

Internal Medicine, Saint Louis University, Saint Louis, MO, USA


Introduction: There is interest improving induction chemotherapy in acute myeloid leukemia. The PALG (Polish Adult Leukemia Group) demonstrated that the addition of cladribine to daunorubicin/cytarabine resulted in improved CR rates and overall survival in untreated AML patients 500 was 23 (range 2143) in those who achieved a CR in 1 course. The median day to achievement of platelet transfusion independence with transfusion threshold of 10K and to platelet count 50K was 21 (range 1928) and 23 (range 2026), respectively, in those who achieved a CR in 1 course. The median number of red blood cell and platelet transfusions in those who achieved CR in 1 course was 8 (range 218) and 6 (range 318), respectively. Death in aplasia etiologies were (all in 1st IAC induction unless otherwise noted): autopsy-proven Aspergillus infections, one disseminated day 14, one pulmonary day 16/ MDR Pseudomonas sepsis and toxic megacolon day 21/ respiratory failure of undetermined etiology with recent stroke day 16 of 2nd IAC induction. Indeterminate deaths were: shock of undetermined etiology with multiorgan failure day 16 / probable Zygomycete pulmonary infection day 37. 25/34 patients (74%) had documented infection during induction. Conclusion: We found a high complete remission rate of IAC in younger patients with an acceptable 30 day mortality rate in spite of short follow-up. We believe that the addition of cladribine to induction chemotherapy with intensified daunorubicin or idarubicin for acute myeloid leukemia warrants further study. Disclosures: Off Label Use: Cladribine was utilized off-label in this study based on prior reports of efficacy in untreated and relapsed acute myeloid leukemia patients.

abstract No: 


Full conference title: 

53rd American Society of Haematology
    • ASH 53rd (2011)