Prolonged treatment with arsenic trioxide (ATO) and all-trans-retinoic acid (ATRA) for relapsed acute promyelocytic leukemia previously treated with ATRA and chemotherapy

Autor: Tiziana Ottone, Daniela Diverio, Robin Foà, Maria Teresa Voso, Valentina Alfonso, Massimo Breccia, Laura Cicconi, Roberto Latagliata, Luca Franceschini, Matteo Molica, Manuela Rizzo, Licia Iaccarino, Francesco Lo-Coco, Mariadomenica Divona
Rok vydání: 2018
Předmět:
Male
medicine.medical_treatment
ATO
ATRA
Acute promyelocytic leukemia
Molecular relapse
Stem cell transplant
Salvage therapy
Kaplan-Meier Estimate
Hematopoietic stem cell transplantation
Gastroenterology
Arsenicals
chemistry.chemical_compound
0302 clinical medicine
Arsenic Trioxide
Leukemia
Promyelocytic
Acute
Recurrence
Antineoplastic Combined Chemotherapy Protocols
Arsenic trioxide
Aged
80 and over
Remission Induction
Hematopoietic Stem Cell Transplantation
Oxides
Hematology
General Medicine
Middle Aged
Combined Modality Therapy
Treatment Outcome
030220 oncology & carcinogenesis
Female
medicine.drug
Adult
medicine.medical_specialty
Tretinoin
Disease-Free Survival
Drug Administration Schedule
Young Adult
03 medical and health sciences
Internal medicine
medicine
Humans
neoplasms
Aged
Proportional Hazards Models
Retrospective Studies
Salvage Therapy
Chemotherapy
business.industry
medicine.disease
Regimen
chemistry
Drug Evaluation
business
Settore MED/15 - Malattie del Sangue
Progressive disease
Follow-Up Studies
030215 immunology
Zdroj: Annals of Hematology. 97:1797-1802
ISSN: 1432-0584
0939-5555
Popis: Prolonged therapy with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) is highly effective in newly diagnosed acute promyelocytic leukemia (APL) but there is limited data on the efficacy of this regimen in the relapse setting. We report here on 22 APL patients treated with prolonged ATRA-ATO therapy at the time of disease relapse. Twenty patients obtained molecular complete remission (CRm) after 2 cycles (90%). Of these, two patients underwent hematopoietic stem cell transplant (HSCT) while the remaining proceeded to receive additional cycles (up to a total of 5) of ATRA-ATO. With a median follow-up of 58 months from the time of relapse (range: 21-128 months), the 4-year OS probability was 0.85 (95% CI 0.61-0.94), DFS was 0.74 (95% CI 0.49-0.88), and EFS 0.68 (95% CI 0.45-0.83). Two patients were resistant to ATRA-ATO salvage and five relapsed at a median of 19 months. Of these, four died due to progressive disease while three relapsed achieved a new CRm after further salvage therapy. This experience confirms the potentially curative effect of prolonged ATRA-ATO therapy in relapsed APL, especially in patients with long first complete remission.
Databáze: OpenAIRE
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