Effect of Dose Ratio on Mitoxantrone and Daunorubicin in Acute Myeloid Leukemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials |
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| Authors: | Lei Deng Changjian Zhang Sunyang Ying Bo Cai Fang Zhou |
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| Affiliation: | 1. The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China;2. The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China;3. University of Chinese Academy of Sciences, Beijing, China;4. The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China;1. Department of Pediatrics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey;2. Department of Pediatric Hematology-Oncology, Istanbul University Oncology Institute, Istanbul, Turkey;1. Department of Haematology, All India Institute of Medical Sciences, New Delhi, India;2. Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India;3. Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India;4. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India;1. Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France;2. Department of Pathology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, INSERM UMR-S 955, Université Paris Est Créteil, Creteil, France;3. Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France;4. Department of Pharmacy, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France;5. Department of Nuclear Medicine, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France;1. Department of Hematology, Instituto Nacional de Cancerología, Mexico City, Mexico;2. Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, “Salvador Zubirán”, Mexico City, Mexico |
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| Abstract: | PurposeTo investigate the effects of mitoxantrone and daunorubicin in induced chemotherapy on complete remission (CR), death during induction therapy, overall survival (OS), disease-free survival (DFS), and relapse in patients of all ages with acute myeloid leukemia (AML).MethodsWe searched published reports at the Medline, Embase, and Cochrane Databases as well as other databases from inception through July 2019. There was no restriction on date of publication or language (PROSPERO registration CRD42018095843).ResultsWe enrolled 12 randomized controlled trials that included data of 4583 AML patients whose disease was untreated or relapsed/refractory, and compared the CR, death during induction therapy, DFS, and OS between mitoxantrone and daunorubicin. Mitoxantrone significantly increased the CR rate (relative risk = 1.07; 95% confidence interval [CI], 1.01, 1.14; P = .03) and DFS (hazard ratio = 0.87; 95% CI, 0.79, 0.96; P = .005) compared to daunorubicin. However, there was no significant difference in death during induction therapy (relative risk = 1.00; 95% CI, 0.81, 1.24; P = .99) and OS (hazard ratio = 0.94; 95% CI, 0.87, 1.01; P = .077) between the two drugs.ConclusionAlthough more studies are needed to compare mitoxantrone with higher-dose daunorubicin, the results showed that compared to daunorubicin, mitoxantrone can significantly improve CR and DFS in patients of all ages. These findings suggest that mitoxantrone may be a better choice than daunorubicin as an induction chemotherapy agent for AML patients, especially in developing countries. |
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| Keywords: | Acute myeloid leukemia Daunorubicin Dose Ratio Mitoxantrone Randomized controlled trials |
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