TY - JOUR
T1 - Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab
AU - Abaza, Yasmin
AU - Kantarjian, Hagop
AU - Garcia-Manero, Guillermo
AU - Estey, Elihu
AU - Borthakur, Gautam
AU - Jabbour, Elias
AU - Faderl, Stefan
AU - O'Brien, Susan
AU - Wierda, William
AU - Pierce, Sherry
AU - Brandt, Mark
AU - McCue, Deborah
AU - Luthra, Rajyalakshmi
AU - Patel, Keyur
AU - Kornblau, Steven
AU - Kadia, Tapan
AU - Daver, Naval
AU - DiNardo, Courtney
AU - Jain, Nitin
AU - Verstovsek, Srdan
AU - Ferrajoli, Alessandra
AU - Andreeff, Michael
AU - Konopleva, Marina
AU - Estrov, Zeev
AU - Foudray, Maria
AU - McCue, David
AU - Cortes, Jorge
AU - Ravandil, Farhad
N1 - Publisher Copyright:
© 2017 by The American Society of Hematology.
PY - 2017/3/9
Y1 - 2017/3/9
N2 - The combination of all-trans-retinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of standard-risk patients with newly diagnosed acute promyelocytic leukemia (APL). A recent study demonstrated the efficacy of this regimen with added gemtuzumab ozogamicin (GO) in high-risk patients. We examined the long-term outcome of patients with newly diagnosed APL treated at our institution on 3 consecutive prospective clinical trials, using the combination of ATRA and ATO, with or without GO. For induction, all patients received ATRA (45 mg/m2 daily) and ATO (0.15 mg/kg daily) with a dose of GO (9 mg/m2 on day 1) added to high-risk patients (white blood cell count, >10 × 109/L), as well as low-risk patients who experienced leukocytosis during induction. Once in complete remission, patients received 4 cycles of ATRA plus ATO consolidation. One hundred eighty-seven patients, including 54 with high-risk and 133 with low-risk disease, have been treated. The complete remission rate was 96% (52 of 54 in high-risk and 127 of 133 in low-risk patients). Induction mortality was 4%, with only 7 relapses. Among low-risk patients, 60 patients (45%) required either GO or idarubicin for leukocytosis. Median duration of follow-up was 47.6 months. The 5-year event-free, disease-free, and overall survival rates are 85%, 96%, and 88%, respectively. Late hematological relapses beyond 1 year occurred in 3 patients. Fourteen deaths occurred beyond 1 year; 12 were related to other causes. This study confirms the durability of responses with this regimen.
AB - The combination of all-trans-retinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of standard-risk patients with newly diagnosed acute promyelocytic leukemia (APL). A recent study demonstrated the efficacy of this regimen with added gemtuzumab ozogamicin (GO) in high-risk patients. We examined the long-term outcome of patients with newly diagnosed APL treated at our institution on 3 consecutive prospective clinical trials, using the combination of ATRA and ATO, with or without GO. For induction, all patients received ATRA (45 mg/m2 daily) and ATO (0.15 mg/kg daily) with a dose of GO (9 mg/m2 on day 1) added to high-risk patients (white blood cell count, >10 × 109/L), as well as low-risk patients who experienced leukocytosis during induction. Once in complete remission, patients received 4 cycles of ATRA plus ATO consolidation. One hundred eighty-seven patients, including 54 with high-risk and 133 with low-risk disease, have been treated. The complete remission rate was 96% (52 of 54 in high-risk and 127 of 133 in low-risk patients). Induction mortality was 4%, with only 7 relapses. Among low-risk patients, 60 patients (45%) required either GO or idarubicin for leukocytosis. Median duration of follow-up was 47.6 months. The 5-year event-free, disease-free, and overall survival rates are 85%, 96%, and 88%, respectively. Late hematological relapses beyond 1 year occurred in 3 patients. Fourteen deaths occurred beyond 1 year; 12 were related to other causes. This study confirms the durability of responses with this regimen.
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U2 - 10.1182/blood-2016-09-736686
DO - 10.1182/blood-2016-09-736686
M3 - Article
C2 - 28003274
AN - SCOPUS:85015251442
SN - 0006-4971
VL - 129
SP - 1275
EP - 1283
JO - Blood
JF - Blood
IS - 10
ER -