***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Identifying true therapeutic progress in patients with acute myeloid leukemia ( AML ) requires a comparison of treatment strategies and results on the basis of uniform patient selection . To foster comparability across five clinical studies , we introduced a common st and ard arm combined with a general upfront r and omization and performed prospect i ve analyses with adjustment for differences in prognostic baseline characteristics . PATIENTS AND METHODS Whereas the studies ' own regimens differed in chemotherapies , risk adaption , and guidelines for allogeneic stem-cell transplantation , the st and ard arm contained uniform cytarabine- and anthracycline-based st and ard-dose remission induction and high-dose consolidation courses . RESULTS Of 2,995 evaluable patients aged 16 to 60 years , 290 patients were r and omly assigned to the common st and ard arm . Seventy percent of the 290 achieved complete remissions ( 62 % with complete recovery , 8 % with incomplete recovery ; 95 % CI , 65 % to 76 % ) . Five-year survival probabilities were 44.3 % ( 95 % CI , 37.7 % to 50.7 % ) for overall survival , 44.8 % ( 95 % CI , 37.0 % to 52.2 % ) for relapse-free survival , and 31.5 % ( 95 % CI , 25.7 % to 37.4 % ) for event-free survival . Neither the unadjusted survival probabilities of the Kaplan-Meier method nor their adjustment for prognostic variables in multiple Cox regression models led to statistically significant different results in the three survival end points when the outcomes of each study were compared with the st and ard arm . CONCLUSION A strictly prospect i ve comparison of different treatment strategies in patients with AML did not show clinical ly relevant outcome differences when compared through a common st and ard treatment arm . The results provide a representative basis for further therapeutic approaches The optimal induction for older adults with acute myeloid leukemia ( AML ) is unknown . Several anthracyclines have been proposed , but the data remain equivocal . Additionally , few prospect i ve trials of priming with hematopoietic growth factors to cycle leukemia cells prior to induction chemotherapy have been conducted . Three hundred and sixty-two older adults with previously untreated AML were r and omized to either daunorubicin , idarubicin or mitoxantrone with a st and ard dose of cytarabine as induction therapy .  In addition , 245 patients were also r and omized to receive granulocyte-macrophage colony-stimulating factor ( GM-CSF ) or placebo beginning 2 days prior to induction chemotherapy and continuing until marrow aplasia . No difference was observed in the disease-free overall survival or in toxicity among patients receiving any of the 3 induction regimens or among those receiving growth factor or placebo for priming . However , the complete remission rate for the first 113 analyzable patients , who did not participate in the priming study and started induction therapy 3 to 5 days earlier than those who did , was significantly higher ( 50 % versus 38 % ; P = .03 ) . None of the anthracyclines is associated with improved outcome in older adults . Priming with hematopoietic growth factor did not improve response when compared with placebo . Furthermore , delaying induction therapy in older adults may lead to a lower complete remission rate The first EORTC ( European Organization of Research and Treatment of Cancer ) acute myeloblastic leukemia ( AML ) pilot study ( 58872 ) was conducted between January 1988 and December 1991 . Out of 108 patients , 78 % achieved complete remission ( CR ) , and event-free survival ( EFS ) and survival rates ( s.e . , % ) at 7 years were 40 ( 5 ) and 51 % ( 6 % ) , respectively . It indicated that mitoxantrone could be substituted for conventional anthracyclines in the treatment of childhood AML without inducing cardiotoxicity . The aim of the next EORTC 58921 trial was to compare the efficacy and toxicity of idarubicin vs mitoxantrone in initial chemotherapy courses , further therapy consisting of allogeneic bone marrow transplantation ( alloBMT ) in patients with an HLA-compatible sibling donor or chemotherapy in patients without a donor . Out of 177 patients , recruited between October 1992 and December 2002 , 81 % reached CR . Overall 7-year EFS and survival rates were 49 ( 4 ) and 62 % ( 4 % ) , respectively . Out of 145 patients who received the first intensification , 39 had a sibling donor . In patients with or without a donor , the 7-year disease-free survival ( DFS ) rate was 63 ( 8) and 57 % ( 5 % ) and the 7-year survival rate was 78 ( 7 ) and 65 % ( 5 % ) , respectively . Patients with favorable , intermediate and unfavorable cytogenetic features had a 5-year EFS rate of 57 , 45 and 45 % and a 5-year survival rate of 89 , 67 and 53 % , respectively CCG-2961 incorporated 3 new agents , idarubicin , fludarabine and interleukin-2 , into a phase 3 AML trial using intensive-timing remission induction/consolidation and related donor marrow transplantation or high-dose cytarabine intensification . Among 901 patients under age 21 years , 5-year survival was 52 % , and event-free survival was 42 % .  Survival improved from 44 % between 1996 and 1998 to 58 % between 2000 and 2002 ( P = .005 ) , and treatment-related mortality declined from 19 % to 12 % ( P = .025 ) . Partial replacement of daunomycin with idarubicin in the 5-drug induction combination achieved a remission rate of 88 % , similar to historical controls . Postremission survival was 56 % in patients r and omized to either 5-drug reinduction or fludarabine/cytarabine/idarubicin . For patients with or without a related donor , respective 5-year disease-free survival was 61 % and 50 % ( P = .021 ) ; respective survival was 68 % and 62 % ( P = .425 ) . Donor availability conferred no benefit on those with inv(16 ) or t(8;21 ) cytogenetics . After cytarabine intensification , patients r and omized to interleukin-2 or none experienced similar outcomes . Factors predictive of inferior survival were age more than 16 years , non-white ethnicity , absence of related donor , obesity , white blood cell count more than 100 000 x 10(9)/L , -7/7q- , -5/5q- , and /or complex karyotype . No new agent improved outcomes ; experience may have contributed to better results time PURPOSE To compare the antitumor efficacy of three different anthracyclines in combination with cytarabine and etoposide in adult patients with newly diagnosed acute myeloid leukemia ( AML ) . PATIENTS AND METHODS We r and omly assigned 2,157 patients ( age range , 15 to 60 years ) to receive intensive induction-consolidation chemotherapy containing either daunorubicin , idarubicin , or mitoxantrone . After achieving complete remission ( CR ) , patients were assigned to undergo either allogeneic or autologous stem-cell transplantation ( SCT ) , depending on the availability of a sibling donor . RESULTS The overall CR rate ( 69 % ) was similar in the three groups . Autologous SCT was performed in 37 % of cases in the daunorubicin arm versus only 29 % and 31 % in mitoxantrone and idarubicin , respectively ( P < .001 ) . However , the disease-free survival ( DFS ) and survival from CR were significantly shorter in the daunorubicin arm : the 5-year DFS was 29 % versus 37 % and 37 % in mitoxantrone and idarubicin , respectively . The proportion of patients who underwent allogeneic SCT ( 22 % ) was equivalent in the three treatment groups , and the outcome was similar as well . The [ corrected ] 5-year overall survival rates were 31 % , 34 % , and 34 % , [ corrected ] respectively . CONCLUSION In adult patients with AML who do not receive an allogeneic SCT , the use of mitoxantrone or idarubicin instead of daunorubicin enhances the long-term efficacy of chemotherapy BACKGROUND A complete remission is essential for prolonging survival in patients with acute myeloid leukemia ( AML ) .  Daunorubicin is a cornerstone of the induction regimen , but the optimal dose is unknown . In older patients , it is usual to give daunorubicin at a dose of 45 to 50 mg per square meter of body-surface area . METHODS Patients in whom AML or high-risk refractory anemia had been newly diagnosed and who were 60 to 83 years of age ( median , 67 ) were r and omly assigned to receive cytarabine , at a dose of 200 mg per square meter by continuous infusion for 7 days , plus daunorubicin for 3 days , either at the conventional dose of 45 mg per square meter ( 411 patients ) or at an escalated dose of 90 mg per square meter ( 402 patients ) ; this treatment was followed by a second cycle of cytarabine at a dose of 1000 mg per square meter every 12 hours [ DOSAGE ERROR CORRECTED ] for 6 days . The primary end point was event-free survival . RESULTS The complete remission rates were 64 % in the group that received the escalated dose of daunorubicin and 54 % in the group that received the conventional dose ( P=0.002 ) ; the rates of remission after the first cycle of induction treatment were 52 % and 35 % , respectively ( P<0.001 ) . There was no significant difference between the two groups in the incidence of hematologic toxic effects , 30-day mortality ( 11 % and 12 % in the two groups , respectively ) , or the incidence of moderate , severe , or life-threatening adverse events ( P=0.08 ) . Survival end points in the two groups did not differ significantly overall , but patients in the escalated-treatment group who were 60 to 65 years of age , as compared with the patients in the same age group who received the conventional dose , had higher rates of complete remission ( 73 % vs. 51 % ) , event-free survival ( 29 % vs. 14 % ) , and overall survival ( 38 % vs. 23 % ) . CONCLUSIONS In patients with AML who are older than 60 years of age , escalation of the dose of daunorubicin to twice the conventional dose , with the entire dose administered in the first induction cycle , effects a more rapid response and a higher response rate than does the conventional dose , without additional toxic effects . ( Current Controlled Trials number , IS RCT N77039377 ; and Netherl and s National Trial Register number , NTR212 . Between 1990 and 1996 , we conducted a r and omized trial in adults with newly diagnosed acute myeloid leukemia ( AML ) in order to compare relapse-free interval ( RFI ) after double induction ( arm B ) , timed-sequential induction ( arm C ) , or control " 3 + 7 " induction ( arm A ) . Patients achieving complete remission ( CR ) after induction + /- salvage received the same consolidation chemotherapy , which included a dosage stratification according to patient 's age ( younger or older than 50 years ) . This long-term analysis was performed in 592 patients ( arm A/B/C , 197/198/197 patients ) .  Overall CR rate was 76 % without differences between the 3 arms , even if a salvage course was less frequently needed in arm B. Treatment-related mortality , either during the induction or the postremission phase , was not significantly higher in arms B and C than in arm A. Among the 449 CR patients , 250 relapsed  ( arm A/B/C , 90/87/73 patients ) without significant differences in RFI in arms B and C versus arm A ( P = .39 and .15 , by the Gray test ) . However , when analyzing the 345 patients younger than 50 , RFI was significantly improved in younger patients receiving timed-sequential induction ( P = .038 by the Gray test ) , while not in those receiving double induction .  Event-free survival and overall survival were similar in the 3 r and omization arms PURPOSE In patients with acute myeloid leukemia ( AML ) , induction chemotherapy is based on st and ard doses of anthracyclines and cytarabine . High doses of cytarabine have been reported as being too toxic for patients older than age 50 years , but few studies have evaluated intensified doses of anthracyclines . PATIENTS AND METHODS In this r and omized Acute Leukemia French Association 9801 ( ALFA-9801 ) study , high doses of daunorubicin ( DNR ; 80 mg/m(2)/d x 3 days ) or idarubicin ( ID 
    Output:
    
Neither study reported on QoL. AUTHORS ' CONCLUSIONS Compared with DNR in induction therapy of newly diagnosed AML , IDA prolongs OS and DFS , increases CR rate and reduces relapse rate , although increases the risks of death on induction therapy and grade 3/4 mucositis .
The currently available evidence does not show any difference between IDA and MIT used in induction therapy of newly diagnosed AML .
Additionally , there is no evidence for difference on the effect of IDA compared with DNR , MIT , DOX or ZRB on