CPX-351 versus 7+3 chemotherapy in older adults with newly diagnosed secondary acute myeloid leukaemia
A liposomal formulation locking cytarabine and daunorubicin in a fixed ratio lengthened survival compared with standard 7+3 chemotherapy in patients aged 60 to 75 with secondary or therapy-related acute myeloid leukaemia, and more of them reached transplant.
Overview
Phase 3 trial of 309 patients aged 60 to 75 with newly diagnosed high-risk or secondary AML randomised to CPX-351 or conventional cytarabine plus daunorubicin (7+3).
Median overall survival was 9.56 months with CPX-351 against 5.95 months with 7+3 (hazard ratio 0.69); remission rates were higher and outcomes after transplant were better, with a longer recovery of blood counts as the main cost.
- Median overall survival 9.56 vs 5.95 months; hazard ratio 0.69.
- Complete remission (with or without incomplete recovery) 47.7 percent vs 33.3 percent.
CPX-351 is the preferred intensive induction for fit older patients with secondary or therapy-related AML in many centres, mainly as a bridge to allogeneic transplant.
- Open-label; longer neutropenia and thrombocytopenia with CPX-351.
- Benefit in patients under 60 and in de novo AML is not established.
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