Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy
Por:
Martinez-Cuadron, D, Montesinos, P, Vellenga, E, Bernal, T, Salamero, O, Holowiecka, A, Brunet, S, Gil, C, Benavente, C, Ribera, J, Perez-Encinas, M, De la Serna, J, Esteve, J, Rubio, V, Gonzalez-Campos, J, Escoda, L, Amutio, M, Arnan, M, Arias, J, Negri, S, Lowenberg, B, Sanz, M, PETHEMA Grp, HOVON Grp, PALG Grp and GATLA Grp
Publicada:
1 ene 2018
Resumen:
Treatment outcome in older patients with acute promyelocytic leukemia (APL) is lower compared with younger patients, mainly because of a higher induction death rate and postremission non-relapse mortality (NRM). This prompted us to design a risk-and age-adapted protocol (Programa Espanol de Tratamientos en Hematologia (PETHEMA)/HOVON LPA2005), with dose reduction of consolidation chemotherapy. Patients aged >= 60 years reported to the PETHEMA registry and were treated with all-trans retinoic acid (ATRA) plus anthracycline-based regimens according to three consecutive PETHEMA trials that were included. We compared the long-term outcomes of the LPA2005 trial with the preceding PETHEMA trials using non-age-adapted schedules (LPA96&LPA99). From 1996 to 2012, 389 older patients were registered, of whom 268 patients (69%) were eligible. Causes of ineligibility were secondary APL (19%), and unfit for chemotherapy (11%). Median age was 67 years, without relevant differences between LPA2005 and LPA96&LPA99 cohorts. Overall, 216 patients (81%) achieved complete remission with no differences between trials. The 5-year NRM, cumulative incidence of relapse, disease-free survival and overall survival in the LPA2005 vs the LPA96&99 were 5 vs 18% (P = 0.15), 7 vs 12% (P = 0.23), 87 vs 69% (P = 0.04) and 74 vs 60% (P = 0.06). A less intensive front-line regimen with ATRA and anthracycline monochemotherapy resulted in improved outcomes in older APL patients.
Filiaciones:
Martinez-Cuadron, D:
Hosp Univ & Politecn La Fe, Valencia, Spain
Inst Carlos III, CIBERONC, Madrid, Spain
Montesinos, P:
Hosp Univ & Politecn La Fe, Valencia, Spain
Inst Carlos III, CIBERONC, Madrid, Spain
Vellenga, E:
Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
Bernal, T:
Hosp Cent Asturias, Oviedo, Spain
Salamero, O:
Hosp Univ Vall dHebron, Barcelona, Spain
Holowiecka, A:
Silesian Med Univ, Katowice, Poland
Brunet, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Barcelona, Spain
:
Hosp Gen, Alicante, Spain
Benavente, C:
Hosp Clin San Carlos, Madrid, Spain
Ribera, J:
ICO Hosp Univ Germans Trias & Pujol, Jose Carreras Res Inst, Badalona, Spain
Perez-Encinas, M:
Hosp Clin, Santiago De Compostela, Spain
De la Serna, J:
Hosp 12 Octubre, Madrid, Spain
Esteve, J:
Hosp Clin Barcelona, Barcelona, Spain
Rubio, V:
Hosp Gen, Jerez de la Frontera, Spain
Gonzalez-Campos, J:
Hosp Univ Virgen del Rocio, Seville, Spain
Escoda, L:
Hosp Joan 23, Tarragona, Spain
Amutio, M:
Hosp Univ Cruces, Bizkaia, Spain
Arnan, M:
ICO Hosp Duran & Reynals, Lhospitalet De Llobregat, Spain
Arias, J:
Hosp Univ Lucus Augusti, Lugo, Spain
Negri, S:
Hosp Reg Univ Carlos Haya, Malaga, Spain
Lowenberg, B:
Erasmus Univ, Med Ctr, Rotterdam, Netherlands
Sanz, M:
Hosp Univ & Politecn La Fe, Valencia, Spain
Inst Carlos III, CIBERONC, Madrid, Spain
Univ Valencia, Dept Med, Valencia, Spain
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