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

   

Authors:	Kayser, S.; Krzykalla, J.; Elliott, M. A.; Norsworthy, K.; Gonzales, P.; Hills, R. K.; Baer, M. R.; Ráčil, Z.; Mayer, J.; Novak, J.; Žák, P.; Szotkowski, T.; Grimwade, D.; Russell, N. H.; Walter, R. B.; Estey, E. H.; Westermann, J.; Görner, M.; Benner, A.; Krämer, A.; Smith, B. D.; Burnett, A. K.; Thiede, C.; Röllig, C.; Ho, A. D.; Ehninger, G.; Schlenk, R. F.; Tallman, M. S.; Levis, M. J.; Platzbecker, U.
Article Title:	Characteristics and outcome of patients with therapy-related acute promyelocytic leukemia front-line treated with or without arsenic trioxide
Abstract:	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.
Keywords:	treatment; myeloid-leukemia; acute; trans-retinoic acid; pml/rar-alpha; differentiation therapy; consolidation therapy; clonal hematopoiesis; risk-adapted; internal tandem duplication; flt3 gene; additional chromosome-abnormalities
Journal Title:	Leukemia
Volume:	31
Issue:	11
ISSN:	0887-6924
Publisher:	Nature Publishing Group
Date Published:	2017-11-01
Start Page:	2347
End Page:	2354
Language:	English
ACCESSION:	WOS:000414215400008
DOI:	10.1038/leu.2017.92
PROVIDER:	wos
PUBMED:	28322237
PMCID:	PMC6037311
Notes:	Article -- Source: Wos

https://synapse.mskcc.org/synapse/works/has_related_data_chk/118200