1. Daunorubicin during delayed intensification decreases the incidence of infectious complications - a randomized comparison in trial CoALL 08-09.
- Author
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Schramm F, Zimmermann M, Jorch N, Pekrun A, Borkhardt A, Imschweiler T, Christiansen H, Faber J, Feuchtinger T, Schmid I, Beron G, Horstmann MA, and Escherich G
- Subjects
- Antibiotics, Antineoplastic administration & dosage, Bacterial Infections immunology, Bacterial Infections therapy, Bone Marrow drug effects, Chemotherapy-Induced Febrile Neutropenia epidemiology, Chemotherapy-Induced Febrile Neutropenia immunology, Chemotherapy-Induced Febrile Neutropenia therapy, Child, Daunorubicin administration & dosage, Dose-Response Relationship, Drug, Doxorubicin administration & dosage, Doxorubicin adverse effects, Female, Hematopoiesis drug effects, Hematopoiesis immunology, Hospitalization statistics & numerical data, Humans, Incidence, Kaplan-Meier Estimate, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma immunology, Precursor Cell Lymphoblastic Leukemia-Lymphoma mortality, Survival Rate, Treatment Outcome, Virus Diseases etiology, Virus Diseases immunology, Virus Diseases therapy, Antibiotics, Antineoplastic adverse effects, Bacterial Infections epidemiology, Daunorubicin adverse effects, Precursor Cell Lymphoblastic Leukemia-Lymphoma drug therapy, Virus Diseases epidemiology
- Abstract
Anthracyclines are integral components of antileukemic treatment. Apart from cardiotoxicity, myelosuppression and infectious complications have been described for doxorubicin (DOX) and daunorubicin (DNR) as predominant side effects, but little is known about their differential toxicities. To address the question whether DNR is associated with a lower rate of infectious complications compared with DOX, 307 children with newly diagnosed acute lymphoblastic leukemia, enrolled in trial CoALL 08-09, were randomized to receive either DOX 30 mg/m
2 (n = 153) or DNR 36 mg/m2 (n = 154) in delayed intensification. Hematologic toxicities and stomatitis were less frequent in the DNR group resulting in a significantly lower rate of infections in the DNR arm (27% vs. 59%, p < .0001). Survival was equal in both arms (95% SE 2%) (p = .55), with an insignificant difference in the relapse rate (RR 0.12 (SE = 0.03) in the DOX arm vs. 0.16 (SE = 0.04) in the DNR arm; p = .37; Hazard ratio 1.3; 95% confidence interval 0.7-2.6). In conclusion, DNR given in delayed intensification is associated with a lower incidence of infectious complications without loss of efficacy.- Published
- 2019
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