Cytosine Arabinoside, Idarubicin and Divided Dose Etoposide for the Treatment of Acute Myeloid Leukemia in Elderly Patients

Elderly patients with acute myeloid leukemia (AML) have an unfavourable prognoses due to low remission rates, short remission durations, and a high treatment related toxicity. Therefore, new chemotherapy regimens with curative potential, decreased toxicity, and applicability to the majority of these patients are still needed. For remission induction, AML patients ≥ 61 years of age received one to three induction courses of the DIVA regimen (idarubicin 10 mg/m²/d days 1 and 3, etoposide 2 × 60 mg/m²/d every 12 hrs. days 2 to 5, and cytarabine 100 mg/m²/d as continuous i.v. infusion days 1 to 5). After achieving CR, patients received two additional courses of DIVA as consolidation therapy. Forty-two consecutive patients with de novo and secondary AML with a median age of 68 years were entered into this trial while six patients were judged ineligible for medical reasons. 62% of the patients achieved a CR, lasting for a median of 26 weeks. Toxicity was mainly hematologic with an early death rate of 12%. The median overall survival for all patients was 38 weeks, and 51 weeks for the 26 patients who achieved CR. Outcome was not significantly different for patients with de novo compared to secondary AML. In conclusion, DIVA showed a promising antileukemic activity and acceptable toxicity as remission induction therapy for de novo and secondary AML in this negligible selected group of elderly patients. However, relapse rate was high, indicating the need for novel approaches for consolidation and maintenance therapy.