| Autor: |
Schramm F; a Clinic of Pediatric Hematology and Oncology , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany., Zimmermann M; k Research Institute Children's Cancer Centre , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany., Jorch N; b Department of Pediatric Hematology and Oncology , Medical School Hannover , Hannover , Germany., Pekrun A; c Department of Pediatric Hematology and Oncology , Hospital Bielefeld , Bielefeld , Germany., Borkhardt A; d Department of Pediatric Hematology and Oncology , Hospital Bremen-Mitte , Bremen , Germany., Imschweiler T; e Department of Pediatric Oncology, Hematology and Clinical Immunology , University Medical Centre , Düsseldorf , Germany., Christiansen H; f Department of Pediatric Hematology and Oncology , Helios Hospital , Krefeld , Germany., Faber J; g Clinic of Pediatric Hematology and Oncology , University Medical Centre Leipzig , Leipzig , Germany., Feuchtinger T; h Department of Pediatric Hematology/Oncology , University Hospital Mainz , Mainz , Germany., Schmid I; i Dr. von Hauner Children's Hospital , Ludwig Maximilians University , Munich , Germany., Beron G; g Clinic of Pediatric Hematology and Oncology , University Medical Centre Leipzig , Leipzig , Germany., Horstmann MA; a Clinic of Pediatric Hematology and Oncology , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany.; j Department of Pediatric Hematology and Oncology , Helios Hospital , Wiesbaden , Germany., Escherich G; a Clinic of Pediatric Hematology and Oncology , University Medical Centre Hamburg-Eppendorf , Hamburg , Germany. |
| Abstrakt: |
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/m 2 (n = 153) or DNR 36 mg/m 2 (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. |
