Oral Idarubicin in Elderly Acute Leukemia and Myelodyplastic Syndromes

During the last five years, a new anthracycline 4:demethoxy daunorubicin or ldarubicin (IDR) has been found to be useful as an antileukemic agent. IDR is less cardiotoxic and has unequivocal biological activity when administered orally. Therefore, the choice of this oral agent to treat elderly acute non-lymphoid leukemias (ANLL) or myelodysplastic syndromes (MDS) on an out-patient basis is attractive for obvious reasons. In this review we summarize the pharmacological characteristics of IDR, its use in the treatment off acute leukemia, and results reported until now in the literature and our sown results using oral IDR in elderly ANLL and MDS patients. IDR given orally at a total dose of 30 mg/m(2) to 90 mg/m(2) induced complete and partial overall responses, in approximately 50% of elderly ANLL and MDS. These results are comparable to those obtained in the same age category using low dose ARA-C, but with less drug toxicity for the patients. We believe that IDP given orally may be used as an additional tool in the conservative approach in elderly ANLL and MDS, which is a problematic category of patients to treat aggressively with combination intravenous chemotherapy.