Since the introduction of the anthracycline idarubicin for the treatment of acute myelogenous leukemia, clinicians have questioned whether it offers significant benefit over the standard anthracycline, daunorubicin. While the three prospectively randomized US trials that compared these two agents in adults with newly diagnosed disease differed somewhat, all reported an improved remission incidence in patients on the idarubicin arm, and two reported improved survival. Overall survival curves, however--albeit better on the idarubicin arm--are still depressingly low. Nonetheless, even if the compound represents only an incremental improvement, it gives more patients the opportunity for more intensive postinduction therapy, such as bone marrow transplantation, or innovative approaches to eradicating minimal residual disease, such as the use of recombinant interleukin-2. This article describes the mechanism of action and pharmacology of idarubicin and reviews the results of clinical studies to date in both acute myelogenous leukemia and acute lymphoblastic leukemia.
