Daunorubicin during delayed intensification significantly reduced the rate of infections compared to doxorubicin (27% vs. 59%, p < 0.0001) with equal survival.
RCT (n=307)
randomized
Absolute Event Rate: 27% vs 59%
p-value: p=< .0001
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/m2 (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.
Schramm et al. (Tue,) conducted a rct in acute lymphoblastic leukemia (n=307). Daunorubicin vs. Doxorubicin 30 mg/m2 was evaluated on rate of infections (p=< .0001). Daunorubicin during delayed intensification significantly reduced the rate of infections compared to doxorubicin (27% vs. 59%, p < 0.0001) with equal survival.