Effects of Idarubicin and cytosine arabinoside on high-risk myelodysplastic syndromes and acute myeloid leukemia

Abstract：Objective To compare the therapeutic and side effects of idarubicin (IDA) with those of daunorubicin(DNR) in combination with cytosine arabinoside (CA) on high-risk myelodysplastic syndromes and acute myeloid leukemia (AML).Methods 29 patients(18 patients with AML,11 patients with high-risk MDS or AMI7MDS)were treated with IDA(12mg/m~2)for 3d and CA(150mg/m~2)for 7d(IA arm) and 26 patients with AML with DNR(45mg/m~2 )for 3d and CA( 150mg/m~2)for 7d( DA arm)as induction and consolidation therapies. Results (1) For AML patients, the effective rates( CR + PR) were 83. 3% in IA arm and 53. 8% in DA arm( P = 0.042); For patients with higher white blood cell count (≥30×10~9/L) ,the effective rates were 81. 3% in IA arm and 25% in DA arm (P =0.009) ;For elder patients ( ≥ 65y) , the effective rates were 66. 7% in IA arm and 0% in DA arm (P = 0.045);(2) Treatment with IA could also offer significant advantages to high-risk MDS or AML/MDS patients with higher effective rates(83.3%) which was similar to that of AML patients by IA(72.7%). Age and Hyperleukocytosis(≥30 ×10~9/L)could not affect the effective rates in IA arm;(3) The main toxicity of IA was longer myelosuppression with lower WBC below 4 ×10~9/L which was averagely up to (24.1 7.7)d. Hemorrhage, nausea, vomit, hepatic and renal dysfunction and heart toxicity occurred unfrequently. Con-clusion IA was superior to DA as induction and consolidation therapies for AML and also effective for high-risk MDS or MDS-develeped AML. Age and hyperleukocytosis could not affect the effects of IA. IA can be the first therapy choice for the patients with AML and high-risk MDS.