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High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis

High- vs Standard-Dose Daunorubicin in AML Induction Therapy

Authors

  • Bibi Kulsoom Professor, Department of Biochemistry, Postgraduate Institute, Bahria University Health Sciences Campus, Karachi, Pakistan
  • Muhammad Nadeem Consultant Haematologist and Head, Department of Pathology, National Institute of Cardiovascular Diseases, Karachi , Pakistan
  • Hafiza Touseef Sayyar Assistant Professor, Department of Pharmacology , Postgraduate Institute, Bahria University Health Sciences Campus, Karachi, Pakistan

DOI:

https://doi.org/10.51846/jucmd.v4i2.3972

Keywords:

Acute Myeloid Leukemia, Daunorubicin, Event-Free Survival, Complete Remission, Meta-analysis, Overall Survival, Induction Chemotherapy

Abstract

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.

 

Published

29-06-2025

How to Cite

1.
Kulsoom B, Muhammad Nadeem, Hafiza Touseef Sayyar. High-dose versus Standard-dose Daunorubicin in Induction Chemotherapy for Acute Myeloid Leukemia: A Meta-Analysis: High- vs Standard-Dose Daunorubicin in AML Induction Therapy. J Univ Coll Med Dent. [Internet]. 2025 Jun. 29 [cited 2025 Jul. 5];4(2). Available from: https://journals.uol.edu.pk/jucmd/article/view/3972

Issue

Volume 4 Issue 2

Section

Review Articles

License

Copyright (c) 2025 Bibi Kulsoom, Muhammad Nadeem, Hafiza Touseef Sayyar

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