Results of the APML3 trial incorporating all-trans-retinoic acid and idarubicin in both induction and consolidation as initial therapy for patients with acute promyelocytic leukemia
| Autor: | Juliana Di Iulio, Harry J. Iland, John F. Seymour, Shane G. Supple, Sandra Deveridge, Marnie Collins, Peter Browett, John Catalano, John V. Reynolds, Mark Hertzberg, Noemi Horvath, Li Chong, Juliet Ayling, Tim Brighton, Kenneth F. Bradstock, Alberto Catalano, Kerry Taylor, Francisca Springall, Paul Cannell, Andrew Grigg |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Acute promyelocytic leukemia Oncology medicine.medical_specialty Tretinoin Pharmacology Young Adult Leukemia Promyelocytic Acute Maintenance therapy Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Idarubicin Survival rate Aged Mercaptopurine business.industry Hazard ratio Induction chemotherapy Consolidation Chemotherapy Induction Chemotherapy Hematology Middle Aged medicine.disease Survival Rate Female Original Articles and Brief Reports business Follow-Up Studies medicine.drug |
| Zdroj: | Haematologica. 97:227-234 |
| ISSN: | 1592-8721 0390-6078 |
| Popis: | Background Initial therapy for patients with acute promyelocytic leukemia most often involves the combination of all- trans -retinoic acid with anthracycline-based chemotherapy. The role of non-anthracycline drugs in induction and consolidation is less well-established and varies widely between different cooperative group protocols. Design and Methods In an attempt to minimize relapse and maximize survival for patients with newly diagnosed acute promyelocytic leukemia, the Australasian Leukaemia and Lymphoma Group utilized all- trans -retinoic acid and idarubicin as anti-leukemic therapy for both induction and consolidation. The protocol (known as APML3) was subsequently amended to incorporate maintenance with all- trans -retinoic acid, methotrexate and 6-mercaptopurine. Results Eight (8%) of 101 patients died within 30 days, and 91 (90%) achieved complete remission. With a median estimated potential follow-up of 4.6 years, 4-year overall survival was 84%, and 71% of the patients remained in remission at 4 years. The cumulative incidence of all relapses was 28.1%, with 15 of the 25 relapses initially identified as an isolated molecular relapse. Both FLT3 mutations (internal tandem duplications and codon 835/836 kinase domain mutations) and increased white cell count at diagnosis were associated with inferior overall survival, but in multivariate analyses only FLT3 mutations remained significant (hazard ratio 6.647, P =0.005). Maintenance therapy was significantly associated with improved remission duration (hazard ratio 0.281, P |
| Databáze: | OpenAIRE |
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