Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia
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Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/ retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse- free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10- year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions: Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.
Abstract
Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/ retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse- free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10- year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions: Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.
참고문헌 (25)
- Kingsley EC, "Acute promyelocytic leukemia", West J Med, 146, pp.322~327 (1987)
- Marty M, "Acute promyelocytic leukemia : retrospective study of 119 patients treated with daunorubicin", Nouv Rev Fr Hematol, 26, pp.371~378 (1984)
- Dombret H, "Combined therapy with all-trans-retinoic acid and high-dose chemotherapy in patients with hyperleukocytic acute promyelocytic leukemia and severe visceral hemorrhage", Leukemia, 6, pp.1237~1242 (1992)
- Tallmann MS, "Curative therapeutic approaches to APL", Ann Hematol, 83(Suppl 1), pp.S81~S82 (2004)
- Krsnik I, "Bleeding in acute promyelocytic leukemia(APL) : fibrinolysis or defibrination?", Nouv Rev Fr Hematol, 33, pp.39~41 (1991)
- Sakata Y, "The specific activity of plasminogen activator inhibitor-1 in disseminated intravascular coagulation with acute promyelocytic leukemia", Blood, 77, pp.1949~1957 (1991)
- Stein E, "The coagulopathy of acute promyelocytic leukaemia revisited", Best Pract Res Clin Haematol, 22, pp.153~163 (2009)
- Ades L, "Arsenic trioxide is required in the treatment of newly diagnosed acute promyelocytic leukemia : analysis of a randomized trial(APL 2006)by the French Belgian Swiss APL group", Haematologica, 103, pp.2033~2039 (2018)
- Zhu HH, "The simpler, the better : oral arsenic for acute promyelocytic leukemia", Blood, 134, pp.597~605 (2019)
- Cicconi L, "Long-term results of all-trans retinoic acid and arsenic trioxide in non-high-risk acute promyelocytic leukemia : update of the APL0406 Italian-German randomized trial", Leukemia, 34, pp.914~918 (2020)
- Sanz MA, "Risk-adapted treatment of acute promyelocytic leukemia with all-trans-retinoic acid and anthracycline monochemotherapy : a multicenter study by the PETHEMA group", Blood, 103, pp.1237~1243 (2004)
- Avvisati G, "Induction therapy with idarubicin alone significantly influences event-free survival duration in patients with newly diagnosed hypergranular acute promyelocytic leukemia : final results of the GIMEMA randomized study LAP 0389 with 7 years of minimal follow-up", Blood, 100, pp.3141~3146 (2002)
- Sanz MA, "Management of acute promyelocytic leukemia : recommendations from an expert panel on behalf of the European LeukemiaNet", Blood, 113, pp.1875~1891 (2009)
- Coombs CC, "Acute promyelocytic leukemia : where did we start, where are we now, and the future", Blood Cancer J, 5, pp.e304~ (2015)
- Cicconi L, "Current management of newly diagnosed acute promyelocytic leukemia", Ann Oncol, 27, pp.1474~1481 (2016)
- Li X, "Combined chemotherapy for acute promyelocytic leukemia : a meta-analysis", Hematology, 22, pp.450~459 (2017)
- Platzbecker U, "Improved outcomes with retinoic acid and arsenic trioxide compared with retinoic acid and chemotherapy in non-high-risk acute promyelocytic leukemia : final results of the randomized Italian-German APL0406 Trial", J Clin Oncol, 35, pp.605~612 (2017)
- Gill H, "Long-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens : a 15-year prospective study", Cancer, 124, pp.2316~2326 (2018)
- Sanz MA, "Management of acute promyelocytic leukemia : updated recommendations from an expert panel of the European LeukemiaNet", Blood, 133, pp.1630~1643 (2019)
- Wang ZY, "Acute promyelocytic leukemia : from highly fatal to highly curable", Blood, 111, pp.2505~2515 (2008)
- Eghtedar A, "Incidence of secondary neoplasms in patients with acute promyelocytic leukemia treated with all-trans retinoic acid plus chemotherapy or with all-trans retinoic acid plus arsenic trioxide", Leuk Lymphoma, 56, pp.1342~1345 (2015)
- Cordonnier C, "Acute promyelocytic leukemia in 57 previously untreated patients", Cancer, 55, pp.18~25 (1985)
- Hoyle CF, "Beneficial effect of heparin in the management of patients with APL", Br J Haematol, 68, pp.283~289 (1988)
- Martinez-Cuadron D, "Longterm outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy", Leukemia, 32, pp.21~29 (2018)
- Norsworthy KJ, "Second cancers in adults with acute promyelocytic leukemia treated with or without arsenic trioxide : a SEER-Medicare analysis", Leukemia, 34, pp.3082~3084 (2020)