Induction of acute myeloid leukemia (AML) with idarubicin, cytarabine and cladribine (ICC).

Efficacy and Toxicity of Induction Therapy with Cladribine, Idarubicin, and Cytarabine (IAC) for Acute Myeloid Leukemia

“…This report is unique due to the detailed review of toxicities associated with IAC and the older age group of patients. Additionally, SLU uses higher doses of idarubicin and cytarabine in combination with cladribine compared to other published studies (10,11). Several caveats limit the interpretation of this study, namely it is a single-arm, retrospective chart review with a limited number of patients.…”

“…Shen et al also showed that IAC was as effective (CR=77.8 vs. 63%) and tolerable as idarubicin and cytarabine (10). In another retrospective study, 24 patients received IAC (some with lower dose cytarabine) and 79.2% achieved a CR within 30 days, and 33-month overall survival of 56% and 36% disease-free survival was recorded (11).…”

“…At Saint Louis University Hospital (SLU), DAC has been modified to use idarubicin (IAC) as the preferred anthracycline (8,9). Two retrospective reviews found substitution of daunorubicin by idarubicin in combination with cladribine and cytarabine was safe and effective (10,11). In contrast with the PALG studies (5, 6), SLU routinely utilizes IAC induction in patients over 60 years of age.…”

Observation Versus Immediate Reinduction for Acute Myeloid Leukemia Patients With Indeterminate Day 14 Bone Marrow Results

“…5,6 Of the patients with newly diagnosed AML, 10% to 40% will not achieve CR after anthracycline-containing induction therapy. 7,8 In the United States, the initial response to induction therapy has been commonly assessed with a bone marrow evaluation performed on day 14. The morphologic evaluation of the day 14 bone marrow is simple and inexpensive to perform but, at the same time, is also nonspecific.…”

Evaluating the Impact of the Addition of Cladribine to Standard Acute Myeloid Leukemia Induction Therapy

“…22 Whereas 7+3+5 DAC induction has received a category 2A recommendation from the NCCN, no recommendation is made concerning the idarubicin equivalent (7+3+5 IAC). Direct data comparing 7+3 IA and 7+3+5 IAC regimens for initial induction therapy have not been well described; however, several recent studies have demonstrated the possible utility of the 7+3+5 IAC regimen in improving CR at first induction, with reported CR rates of 51% to 79% [23][24][25][26] even in high-risk patients.…”