OBJECTIVETo evaluate the sensitivity of NT-pro-BNP in daunorubicin (DNR) induced myocardial damage by monitoring the level of NT-pro-BNP and myocardial enzymes (CK, CKMB) before and after DNR treatment in childhood acute leukemia (AL) and performing control study.

METHODSSixty-two cases (total 194 samples) which diagnosed as primary AL were enrolled and had received the conventional chemotherapy. According to the cumulative dose of DNR, they were divided into three groups: cumulative dose ≤ 60 mg/m(2) (group A); cumulative dose 60 - 120 mg/m(2) (group B); cumulative dose > 120 mg/m(2) (group C) and 15 cases with idarubicin (IDA) or mitoxantrone (MXR) as altervative to DNR (group D).

RESULTSThere was a significant difference (P = 0.000) in the level of NT-pro-BNP before and after DNR therapy, but did not in the myocardial enzymes activities (CK, P = 0.085 and CKMB, P = 0.076). The level of NT-pro-BNP appeared obviously elevated (P = 0.001) when DNR cumulative dose > 60 mg/m(2). While the level of CKMB did (P = 0.022) until DNR cumulative dose > 120 mg/m(2). In the 15 cases used IDA or MXR as alternative to DNR, the level of NT-pro-BNP fall from (239.9 ± 230.0) ng/L to (137.0 ± 131.9) ng/L (P = 0.024).

CONCLUSION(1) Compared with myocardial enzymes detection, NT-pro-BNP level can predict earlier DNR-induced cardiotoxicity. (2) Selection of the second or third generation anthracycline to treat AL can significantly reduce the cardiotoxicity in children.

This study was aimed to explore the clinical efficacy and toxicity of idarubicin (IA regimen) and daunoru-bicin combined with cytarabine (DA regimen) for treating aged patients with AML as induction chemotherapy. The clinical data of 60 newly diagnosed AML aged patients treated with IA or DA regimen were analyzed retrospectively. IA regimen group included 22 patients (8 male and 14 females with median age of 66 yrs), while the DA regimen group included 38 patients (20 males and 18 females with median age of 64 yrs). The complete remission rate, total effective rate and adverse effects after one chemotherapy course were compared. The results showed that the CR rate in IA regimen group was 63.63%, which was significantly higer than that in DA regimen group (31.58%) (P < 0.05). The total effective rate was 63.63% and 36.84% respectively in IA and DA regimen groups, there was significant difference between the two groups (P < 0.05). Both the hematological and non-hematological adverse effects were observed and no difference was found in the two regimen groups, neither in myelosupression (P > 0.05), the major hematological adverse effects, nor in non-hematological adverse effects (P > 0.05). It is concluded that for aged AML patients, IA regimen can achieve a higher CR rate and higher total effective rate than that in DA regimen without increase of adverse effects after one induction chemotherapy course.
Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cytarabine ; administration & dosage ; Female ; Humans ; Idarubicin ; administration & dosage ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Retrospective Studies

Animals ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Humans ; Idarubicin ; administration & dosage ; Leupeptins ; administration & dosage ; Neoplasms ; drug therapy ; pathology ; Neoplastic Stem Cells ; drug effects ; metabolism ; pathology ; physiology

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cytarabine ; administration & dosage ; Daunorubicin ; administration & dosage ; Female ; Humans ; Idarubicin ; administration & dosage ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

The purpose of this study was to assess the efficacy and toxicity of HAI regimen [(homoharringtonine 2.5 mg/(m(2)×d), days 1 - 7; cytarabine 150 mg/(m(2)×d), days 1 - 7; idarubicin 9 mg/(m(2)×d), days 1 - 7)] for induction treatment of newly diagnosed acute myeloid leukemia (AML) (except acute promyelocytic leukemia). 31 patients with newly diagnosed AML, aged 39 (14 - 58) years, were enrolled in this clinical study. The complete remission (CR) rate, especially after one course, the overall survival (OS) rate and relapse free survival (RFS) rate were estimated. The outcomes were compared between different prognostic groups according to World Health Organization (WHO) classification, genetics and initial WBC count. Safety was evaluated using standard WHO criteria. The results showed that 26 patients (84%) achieved CR after 1 course of induction. The CR rate for the patients with favorable, intermediate and unfavorable cytogenetics was 90%, 88% and 60% respectively. All 7 patients with a high initial WBC count (≥ 100×10(9)/L) obtained CR, while 19 out of 24 without a high initial WBC count obtained CR. With a median follow-up of 15(range 2-56) months, the estimated 3-year OS rate for all patients and the patients with CR was 44% and 52% respectively. The 3-year RFS rate was 51%. The patients receiving induction chemotherapy died of the chemotherapy. Profound myelosuppression was seen in all patients after the HAI induction with the median duration of neutropenia (ANC < 0.2×10(9)/L) of 16 (6 - 24) days. As the most common toxicity, severe infections (grade III-IV) involved in all the patients and the duration of febris was 6 (1 - 36) days. The incidence of septemia and invasive fungus infection were 19.4% and 45.2% respectively. The incidence of non-infection fever, increased glutamic-pyruvic transaminase (GPT), diarrhea, increased bilirubin and oral cavity mucositis were 6.5%, 6.5%, 3.2%, 3.2%, 3.2% respectively, as the more frequent severe non-hematological toxicities. It is concluded that HAI regimen is a high efficient induction schedule for the newly diagnosed AML, and archive the higher CR rate after one course than DNR/Ara-C standard induction regimen. Side effects are acceptable, except severe infection.
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cytarabine ; administration & dosage ; therapeutic use ; Female ; Harringtonines ; administration & dosage ; therapeutic use ; Humans ; Idarubicin ; administration & dosage ; therapeutic use ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Young Adult

Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL), yet there is no established treatment for relapsed ALL. To improve the induction remission rate, we modified the dose of idarubicin in the original Children's Cancer Group (CCG)-1884 protocol, and retrospectively compared the results. Twenty-eight patients diagnosed with relapsed ALL received induction chemotherapy according to the CCG-1884 protocol. Complete remission (CR) rate in all patients after induction chemotherapy was 57%. The idarubicin 10 mg/m2/week group showed CR rate of 74%, compared with the 22% CR rate of the idarubicin 12.5 mg/m2/week group (p=0.010). Remission failure due to treatment-related mortality (TRM) was 44% and 5.2% in the idarubicin 12.5 mg/m2/week and 10 mg/m2/week groups, respectively (p=0.011). Overall survival (OS) and 4-yr event-free survival (EFS) were 12.8% and 10.3%, respectively. OS and 4-yr EFS were higher in the idarubicin 10 mg/m2/week group (19.3% and 15.6%) than in the 12.5 mg/m2/week group (0% and 0%). In conclusion, a modified dose of idarubicin from 12.5 mg/m2/week to 10 mg/m2/week resulted in an improved CR rate in the treatment of relapsed ALL, which was due to lower TRM. However, despite improved CR rate with modified dose of idarubicin, survival rates were unsatisfactory.
Adolescent ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Child ; Child, Preschool ; Disease-Free Survival ; Female ; Humans ; Idarubicin/*administration & dosage ; Infant ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/mortality ; Recurrence ; Remission Induction ; Retrospective Studies ; Survival Rate

This study was aimed to investigate the clinical efficacy of idarubicin combined with methotrexate for treatment of patients with central nervous system diffuse large B-cell lymphoma. A total of 88 patients with central nervous system diffuse large B-cell lymphoma was selected, out of them 54 patients received idarubicin combined with methotrexate and were selected as A group, other 34 patients received only methotrexate and were selected as B group (control group). Clinical efficacy and safety were compared after treatment. The results showed that in A group 84 patients achieved complete remission (CR), 5 patients archived partial remission (PR), the total remission rate of A group was 72.2%; in B group 10 patients achieved complete remission (CR), 4 patients archived partial remission (PR), the total remission rate of B group was 41.2%; the average survival time of A group was 33.172 months, and the average survival time of B group was 26.305 months, the former was significantly higher than latter (P < 0.05). It is concluded that idarubicin combined with methotrexate for the patients with central nervous system diffuse large B-cell lymphoma is effective and safe, and may be used in clinic.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Central Nervous System Neoplasms ; drug therapy ; Humans ; Idarubicin ; administration & dosage ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Methotrexate ; administration & dosage ; Remission Induction ; Treatment Outcome

The objective of this study was to investigate the efficacy and toxicity of standard-dose idarubicin in combination with continuous infusion of cytarabine as induction therapy in patients with acute myeloid leukemia (AML). A total of 38 AML patients were enrolled, including 30 new diagnosed patients, 8 relapsed and refractory patients. Cytogenetic analysis was performed in all patients, 15 patients had cytogenetic aberrations including 4 complex abnormalities. All patients were treated with standard-dose idarubicin [12 mg/(m(2).d), days 1 to 3] and continuous infusion of cytarabine [100 mg/(m(2).d), days 1 to 7]. The results showed that after one course of induction therapy, the overall response rate was 89.5% (34/38), and 32 out of 38 (84.2%) patients achieved complete remission (CR), including 27 of 30 (90.0%) new diagnosed AML patients, 5 (62.5%) refractory and relapsed AML patients, all 4 patients with complex cytogenetic aberrations achieved cytogenetic CR. Out of 6 relapsed patients 2 showed as extramedullary relapse, 4 showed as bone marrow relapse. The median survival duration was > 22 months and median disease-free survival time was > 16 months. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicity and the early death were not observed in the patients. It is concluded that standard-dose of idarubicin combined with continuous infusions of cytarabine as the induction therapy is highly effective and well tolerated approach in patients with AML, this regimen provides an opportune moment for hematopoietic stem cell transplantation.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cytarabine ; administration & dosage ; therapeutic use ; Female ; Humans ; Idarubicin ; administration & dosage ; therapeutic use ; Leukemia, Myeloid, Acute ; drug therapy ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

The study was aimed to investigate the different prognosis of acute myeloid leukemia (AML) with inv (16). A 13-year-old patient diagnosed as M4Eo presenting with bulky lymphadenopathy was reported, the curative process of patients was presented and the related issues were discussed. The karyotype and inv (16) were detected by conventional cytogeneties and fluorescence in situ hybridization (FISH), respectively, the immunophenotype was detected by flow cytometry. The results showed that conventional cytogenetics and FISH analysis revealed inv (16). Induction therapy included idarubicin and cytarabine. After complete remission, patient received consolidation theray containing high-dose cytarabine (HDAC). FISH analysis revealed poor response of patient to HDAC. It is concluded that bulky lymphadenopathy in AML with inv (16) may be a negative prognostic sign. FISH for inv (16) is specific and constitutes an reliable tool to be used for diagnosis and minimal residual disease (MRD).
Acute Disease ; Adolescent ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chromosome Inversion ; Chromosomes, Human, Pair 16 ; genetics ; Cytarabine ; administration & dosage ; Humans ; Idarubicin ; administration & dosage ; Leukemia, Myeloid ; complications ; diagnosis ; genetics ; Lymphatic Diseases ; complications ; diagnosis ; genetics ; Male ; Neoplasm, Residual ; Prognosis

Objective: To explore outcomes in adult with de novo acute myeloid leukemia (AML) received IA10 (10 mg/m(2) d1-3 idarubicin plus cytarabine 100 mg/m(2) d1-7) regimen as induction chemotherapy. Methods: From January 2008 to February 2016, data of consecutive newly-diagnosed AML (non-M(3)) adults treated with IA10 who achieved morphologic leukemia-free state (MLFS) but not accepted allogeneic hematopoietic stem cell transplantation (allo-HSCT) were assessed retrospectively. Results: A total of 198 patients were included in this study with 96 (48.5%) male and a median age of 42 years old (range, 18-62 years old). Using the SWOG cytogenetic classification, 45 (22.7%), 104 (52.5%), 24 (12.1%) and 25 (12.6%) patients belonged to favorable, intermediate, unfavorable and unknown categories, respectively. 6 (3.0%) patients had monosomal karyotype, and 28 (14.1%) positive FLT3-ITD mutation. A complete remission (CR, defined as MLFS with ANC ≥ 1×10(9)/L and PLT ≥ 100×10(9)/L) achieved in 168 (84.8%) patients, a CRp (defined as MLFS with incomplete PLT recovery) in 16 (8.1%) and a CRi (defined as MLFS with incomplete ANC and PLT recovery) in 14 (7.1%). With a median follow-up period of 15 months (range, 1 to 70 months) in survivors, the probabilities of cumulative incident of relapse (CIR), disease free survival (DFS) and overall survival (OS) rates at 2-year were 45.2%, 46.9% and 62.9%, respectively; the median durations of relapse, DFS and OS were 34, 20 and 37 months respectively. At the time of achieving first MLFS, multivariate analyses showed that positive FLT3-ITD mutation and CRi were common adverse factors affecting CIR, DFS and OS; unfavorable-risk of SWOG criteria was an adverse factor affecting CIR and DFS; monosomal karyotype was associated with shorter OS. After first consolidation therapy, FLT3-ITD mutation positive and unfavorable-risk of SWOG criteria had negatively impact on CIR, DFS and OS; peripheral blasts ≥ 0.50 and positive MRD (defined as RQ-PCR WT1 mRNA ≥ 0.6% or any level of abnormal blast population detected by flow cytometry) after first consolidation therapy were common adverse factors affecting CIR and DFS; CRi was an adverse factor affecting DFS and OS. Conclusions: In adult with de novo AML received IA10 regimen as induction regimen, unfavorable molecular markers or cytogenetics at diagnosis and CRi independently predicted poor outcome. In addition, a higher percentage of peripheral blasts, monosomal karyotype and positive MRD after first consolidation therapy had negatively impact on outcomes.
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Cytarabine/administration & dosage* ; Disease-Free Survival ; Female ; Humans ; Idarubicin/administration & dosage* ; Induction Chemotherapy ; Leukemia, Myeloid, Acute/drug therapy* ; Male ; Middle Aged ; Prognosis ; Remission Induction ; Retrospective Studies ; Young Adult