Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: further improvements in treatment outcome
| Autor: | Sanz, M.A., Montesinos, P., Rayon, C., Holowiecka, A., de la Serna, J., Milone, G., de Lisa, E., Brunet, S., Rubio, V., Ribera, J.M., Rivas, C, Krsnik, I., Bergua, J., Gonzalez, J., Diaz-Mediavilla, J., Rojas, R., Manso, F., Ossenkoppele, G.J., Gonzalez, J.D., Lowenberg, B., Pethema, G., Hovon, G. |
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| Přispěvatelé: | Hematology, CCA - Innovative therapy |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Acute promyelocytic leukemia Oncology medicine.medical_specialty Adolescent Anthracycline Immunology MULTICENTER Tretinoin Neutropenia Biochemistry Disease-Free Survival PROGNOSTIC-FACTORS COMPETING RISK Risk Factors Internal medicine Antineoplastic Combined Chemotherapy Protocols FAILURE Humans Medicine Idarubicin Anthracyclines Survival rate Aged Mitoxantrone MONOCHEMOTHERAPY business.industry Cytarabine REMISSION Cell Biology Hematology Middle Aged medicine.disease Surgery Survival Rate Leukemia Myeloid Acute IDARUBICIN PETHEMA GROUP Female Risk Adjustment business medicine.drug |
| Zdroj: | BLOOD r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname Sanz, M A, Montesinos, P, Rayon, C, Holowiecka, A, de la Serna, J, Milone, G, de Lisa, E, Brunet, S, Rubio, V, Ribera, J M, Rivas, C, Krsnik, I, Bergua, J, Gonzalez, J, Diaz-Mediavilla, J, Rojas, R, Manso, F, Ossenkoppele, G J, Gonzalez, J D, Lowenberg, B, Pethema, G & Hovon, G 2010, ' Risk-adapted treatment of acute promyelocytic leukemia based on all-trans retinoic acid and anthracycline with addition of cytarabine in consolidation therapy for high-risk patients: further improvements in treatment outcome ', Blood, vol. 115, no. 25, pp. 5137-5146 . https://doi.org/10.1182/blood-2010-01-266007 Blood, 115(25), 5137-5146. American Society of Hematology Blood r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe |
| ISSN: | 0006-4971 |
| Popis: | A risk-adapted strategy based on all-trans retinoic acid (ATRA) and anthracycline monochemotherapy (PETHEMALPA99 trial) has demonstrated a high antileukemic efficacy in acute promyelocytic leukemia. We designed a new trial (LPA2005) with the objective of achieving stepwise improvements in outcome. Between July 2005 and April 2009, low- and intermediate-risk patients (leukocytes < 10 x 10(9)/L) received a reduced dose of mitoxantrone for the second consolidation course, whereas high-risk patients younger than 60 years of age received cytarabine combined with ATRA and idarubicin in the first and third consolidation courses. Of 372 patients attaining complete remission after ATRA plus idarubicin (92.5%), 368 proceeded to consolidation therapy. For low- and intermediate-risk patients, duration of neutropenia and thrombocytopenia and hospital stay were significantly reduced without sacrificing antileukemic efficacy, compared with the previous LPA99 trial. For high-risk patients, the 3-year relapse rate was significantly lower in the LPA2005 trial (11%) than in the LPA99 (26%; P = .03). Overall disease-free survival was also better in the LPA2005 trial (P = .04). In conclusion, the lower dose of mitoxantrone resulted in a significant reduction of toxicity and hospital stay while maintaining the antileukemic activity, and the combination of ATRA, idarubicin, and cytarabine for high-risk acute promyelocytic leukemia significantly reduced the relapse rate in this setting. Registered at http://www.clinicaltrials.gov as NCT00408278. (Blood. 2010; 115(25):5137-5146) |
| Databáze: | OpenAIRE |
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