Nowadays there are several kinds of anthracyclines available, among which idarubicin (IDA) draws more attention because of its theoretical advantages in improving efficacy and reducing side effects. However, clinical trials comparing IDA with other anthracyclines have conflicting results.
To clarify the role of IDA in induction therapy of newly diagnosed AML.
Data from available randomised controlled trials (RCTs) that compared IDA with other anthracyclines in induction therapy of newly diagnosed AML were meta-analysed. The data collected are up to 3 August 2014.
Twenty-seven RCTs involving 9549 patients were included. The consolidation treatments adopted in the included studies were comparable and had no impact on the results.
Eighteen RCTs assessed IDA versus daunorubicin (DNR; a chemotherapy drug in the anthracycline family). Results showed that IDA compared to DNR prolongs overall survival and disease-free survival, increases complete remission rate, and reduces relapse rate, although increases the risks of death on induction therapy and grade 3/4 mucositis (a kind of painful inflammation and ulceration of mucous membranes lining the digestive tract). No difference in other various grade 3/4 adverse events was found.
Eight RCTs evaluated IDA versus mitoxantrone (MIT). We found no difference in overall survival, disease-free survival, complete remission rate, the risks of death on induction therapy and relapse. The risks of various grade 3/4 adverse events were also similar between arms.
Two RCTs compared IDA with doxorubicin (DOX). Results suggested that complete remission rate was improved with IDA. No difference was noted in disease-free survival and the risk of grade 3/4 cardiac toxicity.
Two other RCTs compared IDA with zorubicin (ZRB). Results suggested that the risk of grade 3/4 mucositis was lower with IDA. No difference was found for disease-free survival, complete remission rate, the risks of death on induction therapy, grade 3/4 nausea/vomiting, diarrhoea, and hepatic toxicity.
The currently available evidence suggests that in induction therapy of newly diagnosed AML, IDA is superior to DNR in terms of prolonging overall survival and disease-free survival, increasing complete remission rate and reducing relapse rate, although IDA may increase the risks of death on induction therapy and grade 3/4 mucositis. The current evidence does not support the superiority of IDA over MIT. There is insufficient evidence for clarifying the role of IDA versus DOX or ZRB. Additionally, there is no evidence for a difference on the effect of IDA compared with other anthracyclines (DNR, MIT, DOX and ZRB) on quality of life.
Authors' conclusions:
Compared with DNR in induction therapy of newly diagnosed AML, IDA prolongs OS and DFS, increases CR rate and reduces relapse rate, although increases the risks of death on induction therapy and grade 3/4 mucositis. The currently available evidence does not show any difference between IDA and MIT used in induction therapy of newly diagnosed AML. There is insufficient evidence regarding IDA versus DOX and IDA versus ZRB to make final conclusions. Additionally, there is no evidence for difference on the effect of IDA compared with DNR, MIT, DOX or ZRB on QoL.