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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| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
18 April 2017
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| In: |
Leukemia
Year: 2017, Jahrgang: 31, Heft: 11, Pages: 2347-2354 |
| ISSN: | 1476-5551 |
| DOI: | 10.1038/leu.2017.92 |
| Online-Zugang: | Verlag, Volltext: http://dx.doi.org/10.1038/leu.2017.92 Verlag, Volltext: https://www.nature.com/articles/leu201792 |
| Verfasserangaben: | 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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| 520 | |a 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. | ||
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