Substitution with doxorubicin for daunorubicin during induction for high risk pediatric acute lymphoblastic leukemia results in increased toxicity

摘要

Widespread drug shortages have affected the availability of chemotherapy agents commonly used to treat pediatric ALL [1]. Induction chemotherapy for high risk acute lymphoblastic leukemia (HR ALL) consists of vincristine, PEG-aspargase, daunorubicin, and a glucocorticoid with associated low rates of morbidity and mortality, and a high rate of remission efficacy [2].The shortage of daunorubicin, which began in the spring of 2011, compromised the delivery of standard induction chemotherapy to pediatric HR-ALL patients. Daunorubicin and doxorubicin are historically considered dose equivalent in the treatment of ALL based upon in vitro testing showing similar sensitivity in untreated pediatric ALL samples [3].