High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis
Objective: This systematic review and meta-analysis aimed to compare the efficacy and safety of high-dose versus standard-dose daunorubicin in induction therapy for adult acute myeloid leukemia (AML), focusing on complete remission (CR), overall survival (OS), and event-free survival (EFS). Metho...
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University of Lahore
2025-06-01
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| Series: | Journal of University College of Medicine and Dentistry |
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| Online Access: | https://journals.uol.edu.pk/jucmd/article/view/3972 |
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| author | Bibi Kulsoom Muhammad Nadeem Hafiza Touseef Sayyar |
| author_facet | Bibi Kulsoom Muhammad Nadeem Hafiza Touseef Sayyar |
| author_sort | Bibi Kulsoom |
| collection | DOAJ |
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Objective: This systematic review and meta-analysis aimed to compare the efficacy and safety of high-dose versus standard-dose daunorubicin in induction therapy for adult acute myeloid leukemia (AML), focusing on complete remission (CR), overall survival (OS), and event-free survival (EFS).
Methods: PubMed (Medline), Scopus, Science Direct, and Google Scholar were comprehensively and systematically explored for literature published in English, published from inception till January 30, 2025. Eligible studies included RCTs and retrospective cohorts comparing high-dose (>60 mg/m²/day) versus standard-dose (45–60 mg/m²/day) daunorubicin in adult AML patients, reporting at least one of the following outcomes: CR, OS, or EFS. Ten studies met eligibility criteria. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses were performed based on standard-dose levels (45 vs. 60 mg/m²). Heterogeneity and sensitivity analyses were also conducted.
Results: CR rates were numerically higher in the high-dose group but did not reach statistical significance (RR = 1.07; 95% CI: 0.94–1.22; P = 0.32). High-dose daunorubicin significantly improved 1-year OS (RR = 1.14; 95% CI: 1.06–1.23; P = 0.0002) and 5-year OS (RR = 1.32; 95% CI: 1.07–1.63; P = 0.01), especially when compared to the 45 mg/m² dose. While 1-year EFS showed no significant difference, pooled long-term EFS favored the high-dose group (RR = 1.26; 95% CI: 1.01–1.57; P = 0.04). Toxicity profiles were comparable between groups.
Conclusion: High-dose daunorubicin improves OS and long-term EFS in adult AML patients, particularly when compared to a standard dose of 45 mg/m², without increasing serious toxicity. It may be preferred in induction regimens where survival benefit is prioritized.
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| format | Article |
| id | doaj-art-a836ddb8235740efb3a89ea080386648 |
| institution | Kabale University |
| issn | 2790-3443 2790-3451 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | University of Lahore |
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| series | Journal of University College of Medicine and Dentistry |
| spelling | doaj-art-a836ddb8235740efb3a89ea0803866482025-08-20T03:24:51ZengUniversity of LahoreJournal of University College of Medicine and Dentistry2790-34432790-34512025-06-014210.51846/jucmd.v4i2.3972High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-AnalysisBibi Kulsoom0Muhammad Nadeem1Hafiza Touseef Sayyar2Professor, Department of Biochemistry, Postgraduate Institute, Bahria University Health Sciences Campus, Karachi, PakistanConsultant Haematologist and Head, Department of Pathology, National Institute of Cardiovascular Diseases, Karachi , PakistanAssistant Professor, Department of Pharmacology , Postgraduate Institute, Bahria University Health Sciences Campus, Karachi, Pakistan Objective: This systematic review and meta-analysis aimed to compare the efficacy and safety of high-dose versus standard-dose daunorubicin in induction therapy for adult acute myeloid leukemia (AML), focusing on complete remission (CR), overall survival (OS), and event-free survival (EFS). Methods: PubMed (Medline), Scopus, Science Direct, and Google Scholar were comprehensively and systematically explored for literature published in English, published from inception till January 30, 2025. Eligible studies included RCTs and retrospective cohorts comparing high-dose (>60 mg/m²/day) versus standard-dose (45–60 mg/m²/day) daunorubicin in adult AML patients, reporting at least one of the following outcomes: CR, OS, or EFS. Ten studies met eligibility criteria. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analyses were performed based on standard-dose levels (45 vs. 60 mg/m²). Heterogeneity and sensitivity analyses were also conducted. Results: CR rates were numerically higher in the high-dose group but did not reach statistical significance (RR = 1.07; 95% CI: 0.94–1.22; P = 0.32). High-dose daunorubicin significantly improved 1-year OS (RR = 1.14; 95% CI: 1.06–1.23; P = 0.0002) and 5-year OS (RR = 1.32; 95% CI: 1.07–1.63; P = 0.01), especially when compared to the 45 mg/m² dose. While 1-year EFS showed no significant difference, pooled long-term EFS favored the high-dose group (RR = 1.26; 95% CI: 1.01–1.57; P = 0.04). Toxicity profiles were comparable between groups. Conclusion: High-dose daunorubicin improves OS and long-term EFS in adult AML patients, particularly when compared to a standard dose of 45 mg/m², without increasing serious toxicity. It may be preferred in induction regimens where survival benefit is prioritized. https://journals.uol.edu.pk/jucmd/article/view/3972Acute Myeloid LeukemiaDaunorubicinEvent-Free SurvivalComplete RemissionMeta-analysisOverall Survival |
| spellingShingle | Bibi Kulsoom Muhammad Nadeem Hafiza Touseef Sayyar High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis Journal of University College of Medicine and Dentistry Acute Myeloid Leukemia Daunorubicin Event-Free Survival Complete Remission Meta-analysis Overall Survival |
| title | High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis |
| title_full | High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis |
| title_fullStr | High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis |
| title_full_unstemmed | High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis |
| title_short | High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis |
| title_sort | high dose versus standard dose daunorubicin in induction chemotherapy for acute myeloid leukemia a meta analysis |
| topic | Acute Myeloid Leukemia Daunorubicin Event-Free Survival Complete Remission Meta-analysis Overall Survival |
| url | https://journals.uol.edu.pk/jucmd/article/view/3972 |
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