Idarubicin, high-dose cytarabine, and etoposide for induction of remission in acute leukemia

Between 1990 and 1994, 52 newly diagnosed patients with primary (n = 47) or therapy-related (n = 5) acute myeloid leukemia (AML) under the age of 55 years received an induction chemotherapy protocol (designated BF12) consisting of idarubicin ([IDA] 5 mg/m²), high-dose cytarabine ([HD-Ara-C] 2 g/m² per 12 hours, 3-hour infusion), and etoposide ([VP-16] 100 mg/m², 1- hour infusion) on each of 5 consecutive days. Thirty-seven of 51 assessable patients (72.5 %), including all five patients with therapy-related AML, attained remission with one cycle. The overall remission rate was 78.4 %. Total therapy of AML, with BF12 followed by two courses of consolidation therapy and allogeneic or unpurged autologous bone marrow transplantation (BMT) in first remission, has resulted in actuarial 3-year survival of 49.9% of consecutive unseletted patients with newly diagnosed primary AML (minimum follow-up period, 1 year). Twenty-five patients have received BF12 for relapsed acute leukemia, including 13 relapsing after BMT. Five patients died of toxicity and were not assessable for response. Of the remaining 20 patients, five were refractory, two attained partial remission, and 13 (65%) achieved complete remission (CR). Four of the 13 patients relapsing after BMT died of toxicity, four were refractory, and five of nine assessable patients (56%) attained CR. We conclude that the combination IDA/HD-Ara-C/VP-16 is highly effective in the treatment of newly diagnosed AML and relapsed acute leukemia.