Oral arsenic trioxide incorporation into frontline treatment with all-trans retinoic acid and chemotherapy in newly diagnosed acute promyelocytic leukemia: A 5-year prospective study.

Autor: Gill H; Department of Medicine, University of Hong Kong, Hong Kong, China., Kumana CR; Department of Medicine, University of Hong Kong, Hong Kong, China., Yim R; Department of Medicine, University of Hong Kong, Hong Kong, China., Hwang YY; Department of Medicine, University of Hong Kong, Hong Kong, China., Chan TSY; Department of Medicine, University of Hong Kong, Hong Kong, China., Yip SF; Department of Medicine, Tuen Mun Hospital, Hong Kong, China., Lee HKK; Department of Medicine, Princess Margaret Hospital, Hong Kong, China., Mak V; Department of Medicine, Princess Margaret Hospital, Hong Kong, China., Lau JSM; Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China., Chan CC; Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China., Kho B; Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China., Wong RSM; Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China., Li W; Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China., Lin SY; Department of Medicine, United Christian Hospital, Hong Kong, China., Lau CK; Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China., Ip HW; Department of Pathology, Queen Mary Hospital, Hong Kong, China., Leung RYY; Department of Pathology, Queen Mary Hospital, Hong Kong, China., Lam CCK; Department of Pathology, Queen Mary Hospital, Hong Kong, China., Kwong YL; Department of Medicine, University of Hong Kong, Hong Kong, China.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2019 Sep 01; Vol. 125 (17), pp. 3001-3012. Date of Electronic Publication: 2019 May 15.
DOI: 10.1002/cncr.32180
Abstrakt: Background: Strategies using oral arsenic trioxide (As 2 O 3 ) are efficacious in relapsed acute promyelocytic leukemia (APL), but they have not been examined in newly diagnosed cases.
Methods: Sixty-two consecutive patients (24 men and 38 women) with a median age of 52 years (range, 22-85 years), 36% of whom had high-risk features, underwent induction with all-trans retinoic acid at 45 mg/m 2 /d, oral As 2 O 3 at 10 mg/d, and ascorbic acid at 1 g/d (the all-trans retinoic acid-arsenic trioxide-ascorbic acid [AAA] regimen) for 6 weeks (with patients younger than 70 years additionally receiving daunorubicin at 50 mg/m 2 /d × 3); they then underwent consolidation with 2 monthly cycles of daunorubicin (50 mg/m 2 /d × 2) and cytarabine (100 mg/m 2 /d × 5) and received AAA maintenance (2 weeks every 8 weeks) for 2 years. A contemporaneous cohort of 37 newly diagnosed patients (15 men and 22 women) with a median age of 51 years (range, 23-78 years), not consenting to oral As 2 O 3 induction but receiving similar induction, consolidation, and AAA maintenance, served as a comparator group; 46% of these patients had high-risk features.
Results: The oral As 2 O 3 induction cohort showed a complete remission (CR) rate of 100%. After a median of 37 months (range, 13-82 months), there were no relapses, so conventional risks (age, leukocyte and platelet counts, and Fms-like tyrosine kinase 3 [FLT3] mutations) were not relevant. The leukemia-free survival (LFS) and overall survival (OS) rates were 100% at 3 years and 94.1% at 5 years. The non-As 2 O 3 induction cohort showed a CR rate of 100%. After a median of 52 months (range, 14-77 months), there were 3 relapses (8%). Comparable patients in the oral As 2 O 3 induction and non-As 2 O 3 induction cohorts showed similar OS, but LFS was significantly superior in the oral As 2 O 3 induction cohort.
Conclusions: The incorporation of oral As 2 O 3 into induction for newly diagnosed APL was safe and decreased relapses.
(© 2019 American Cancer Society.)
Databáze: MEDLINE
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