Outcome of older (>= 70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study
Por:
Kayser, S, Rahme, R, Martinez-Cuadron, D, Ghiaur, G, Thomas, X, Sobas, M, Guerci-Bresler, A, Garrido, A, Pigneux, A, Gil, C, Raffoux, E, Tormo, M, Vey, N, de la Serna, J, Salamero, O, Lengfelder, E, Levis, M, Fenaux, P, Sanz, M, Platzbecker, U, Schlenk, R, Ades, L and Montesinos, P
Publicada:
1 sep 2020
Ahead of Print:
1 feb 2020
Resumen:
Data on outcome in older (>= 70 years) patients with acute promyelocytic leukemia after treatment with arsenic trioxide (ATO) compared with standard chemotherapy (CTX) is scarce. We evaluated 433 patients (median age, 73.4 years) treated either with ATO+ all-trans retinoic acid (ATO/ATRA; n = 26), CTX/ATRA + ATO during consolidation (CTX/ATRA/ATO; n = 148), or with CTX/ATRA (n = 259). Median follow-up for overall survival (OS) was 4.8 years. Complete remissions (CR) were achieved in 92% with ATO/ATRA and 82% with CTX/ATRA; induction death rates were 8% and 18%, respectively. For analysis of postremission outcomes we combined the ATO/ATRA and CTX/ATRA/ATO groups (ATO/ATRA +/- CTX). Cumulative incidence of relapse (CIR) was significantly lower after ATO/ATRA +/- CTX compared with CTX/ATRA (P < 0.001). The same held true when restricting the analysis according to the treatment period after the year 2000. OS of patients in CR1 was not different between ATO/ATRA +/- CTX compared with CTX/ATRA (P = 0.20). High (>10 x 10(9)/l) white blood cell (WBC) counts at diagnosis were associated with higher CIR (P < 0.001) compared with lower WBC in the CTX/ATRA group, but not in the ATO/ATRA +/- CTX group (P = 0.48). ATO, when added to ATRA or CTX/ATRA is feasible and effective in elderly patients for remission induction and consolidation, particularly in patients with high WBC at diagnosis.
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