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Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide

Therapy-related acute promyelocytic leukemia (t-APL) is relatively rare, with limited data on outcome after treatment with arsenic trioxide (ATO) compared to standard intensive chemotherapy (CTX). We evaluated 103 adult t-APL patients undergoing treatment with all-trans retinoic acid (ATRA) alone (n...

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Bibliographic Details
Main Authors: Kayser, Sabine (Author) , Benner, Axel (Author) , Krämer, Alwin (Author) , Ho, Anthony Dick (Author) , Schlenk, Richard Friedrich (Author)
Format: Article (Journal)
Language:English
Published: 18 April 2017
In: Leukemia
Year: 2017, Volume: 31, Issue: 11, Pages: 2347-2354
ISSN:1476-5551
DOI:10.1038/leu.2017.92
Online Access:Verlag, Volltext: http://dx.doi.org/10.1038/leu.2017.92
Verlag, Volltext: https://www.nature.com/articles/leu201792
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Author Notes:S. Kayser, J. Krzykalla, M.A. Elliott, K. Norsworthy, P. Gonzales, R.K. Hills, M.R. Baer, Z. Ráčil, J. Mayer, J. Novak, P. Žák, T. Szotkowski, D. Grimwade, N.H. Russell, R.B. Walter, E H. Estey, J. Westermann, M. Görner, A. Benner, A. Krämer, B.D. Smith, A.K. Burnett, C. Thiede, C. Röllig, A.D. Ho, G. Ehninger, R.F. Schlenk, M.S. Tallman, M.J. Levis and U. Platzbecker
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Summary:Therapy-related acute promyelocytic leukemia (t-APL) is relatively rare, with limited data on outcome after treatment with arsenic trioxide (ATO) compared to standard intensive chemotherapy (CTX). We evaluated 103 adult t-APL patients undergoing treatment with all-trans retinoic acid (ATRA) alone (n=7) or in combination with ATO (n=24), CTX (n=53), or both (n=19). Complete remissions were achieved after induction therapy in 57% with ATRA, 100% with ATO/ATRA, 78% with CTX/ATRA, and 95% with CTX/ATO/ATRA. Early death rates were 43% for ATRA, 0% for ATO/ATRA, 12% for CTX/ATRA and 5% for CTX/ATO/ATRA. Three patients relapsed, two developed therapy-related acute myeloid leukemia and 13 died in remission including seven patients with recurrence of the prior malignancy. Median follow-up for survival was 3.7 years. None of the patients treated with ATRA alone survived beyond one year. Event-free survival was significantly higher after ATO-based therapy (95%, 95% CI, 82-99%) as compared to CTX/ATRA (78%, 95% CI, 64-87%; P=0.042), if deaths due to recurrence of the prior malignancy were censored. The estimated 2-year overall survival in intensively treated patients was 88% (95% CI, 80-93%) without difference according to treatment (P=0.47). ATO when added to ATRA or CTX/ATRA is feasible and leads to better outcomes as compared to CTX/ATRA in t-APL.
Item Description:Gesehen am 30.07.2018
Physical Description:Online Resource
ISSN:1476-5551
DOI:10.1038/leu.2017.92

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