Randomized study of treatment intensification after not achieving MRD-negativity with induction in older patients with AML

The multicenter randomized NCRI AML 18 trial in the UK evaluated the survival benefit of chemotherapy intensification in older patients (median age 67 years; range 51-79) with AML who did not achieve measurable residual disease (MRD)-negative remission with first induction course of daunorubicin and AraC (DA). Patients were randomized to two additional courses of DA or intensivation of the treatment with FLAG-Ida or DA plus cladribine (DAC). The study found that among all patients, intensification of the treatment did not improve overall survival, but after exclusion of patients with unknown MRD, both intensification groups had better OS than the DA continuation group. DAC intensification was better tolerated than FLAG-Ida. The authors conclude that in this study of older patients with AML considered fit and with evidence of residual disease after first induction, chemotherapy intensification improved survival.