| Autor: |
Martínez-Cuadrón D; Hospital Universitari i Politècnic La Fe, Valencia, Spain.; CIBERONC, Instituto Carlos III, Madrid, Spain., Montesinos P; Hospital Universitari i Politècnic La Fe, Valencia, Spain.; CIBERONC, Instituto Carlos III, Madrid, Spain., Vellenga E; University Hospital, Groningen, The Netherlands., Bernal T; Hospital Central de Asturias, Oviedo, Spain., Salamero O; Hospital Universitario Vall d´Hebron, Barcelona, Spain., Holowiecka A; Silesian Medical University, Katowice, Poland., Brunet S; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Gil C; Hospital General, Alicante, Spain., Benavente C; Hospital Clínico San Carlos, Madrid, Spain., Ribera JM; ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain., Pérez-Encinas M; Hospital Clínico, Santiago de Compostela, Spain., De la Serna J; Hospital 12 de Octubre, Madrid, Spain., Esteve J; Hospital Clinic, Barcelona, Spain., Rubio V; Hospital General, Jerez de la Frontera, Spain., González-Campos J; Hospital Universitario Virgen del Rocío, Sevilla, Spain., Escoda L; Hospital Joan XXIII, Tarragona, Spain., Amutio ME; Hospital Universitario Cruces, Bizkaia, Spain., Arnan M; ICO-Hospital Duran i Reynals, Hospitalet del Llobregat, Spain., Arias J; Hospital Universitario Lucus Augusti, Lugo, Spain., Negri S; Hospital Regional Universitario Carlos Haya, Málaga, Spain., Lowënberg B; Erasmus University Medical Center, Rotterdam, The Netherlands., Sanz MA; Hospital Universitari i Politècnic La Fe, Valencia, Spain.; CIBERONC, Instituto Carlos III, Madrid, Spain.; Department of Medicine, University of Valencia, Valencia, Spain. |
| Abstrakt: |
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 Español de Tratamientos en Hematología (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. |
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