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Multicenter Study
. 2020 Sep;34(9):2333-2341.
doi: 10.1038/s41375-020-0758-4. Epub 2020 Feb 19.

Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study

Sabine Kayser  1   2   3 , Ramy Rahmé  4 , David Martínez-Cuadrón  5   6 , Gabriel Ghiaur  7 , Xavier Thomas  8 , Marta Sobas  9 , Agnes Guerci-Bresler  10 , Ana Garrido  11 , Arnaud Pigneux  12 , Cristina Gil  13 , Emmanuel Raffoux  4 , Mar Tormo  14 , Norbert Vey  15 , Javier de la Serna  16 , Olga Salamero  17 , Eva Lengfelder  18 , Mark J Levis  7 , Pierre Fenaux  4 , Miguel A Sanz  5   6 , Uwe Platzbecker  19 , Richard F Schlenk  20   21 , Lionel Adès #  4 , Pau Montesinos #  5   6
Affiliations
Multicenter Study

Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study

Sabine Kayser et al. Leukemia. 2020 Sep.

Erratum in

Abstract

Data on outcome in older (≥70 years) patients with acute promyelocytic leukemia after treatment with arsenic trioxide (ATO) compared with standard chemotherapy (CTX) is scarce. We evaluated 433 patients (median age, 73.4 years) treated either with ATO+ all-trans retinoic acid (ATO/ATRA; n = 26), CTX/ATRA + ATO during consolidation (CTX/ATRA/ATO; n = 148), or with CTX/ATRA (n = 259). Median follow-up for overall survival (OS) was 4.8 years. Complete remissions (CR) were achieved in 92% with ATO/ATRA and 82% with CTX/ATRA; induction death rates were 8% and 18%, respectively. For analysis of postremission outcomes we combined the ATO/ATRA and CTX/ATRA/ATO groups (ATO/ATRA ± CTX). Cumulative incidence of relapse (CIR) was significantly lower after ATO/ATRA ± CTX compared with CTX/ATRA (P < 0.001). The same held true when restricting the analysis according to the treatment period after the year 2000. OS of patients in CR1 was not different between ATO/ATRA ± CTX compared with CTX/ATRA (P = 0.20). High (>10 × 109/l) white blood cell (WBC) counts at diagnosis were associated with higher CIR (P < 0.001) compared with lower WBC in the CTX/ATRA group, but not in the ATO/ATRA ± CTX group (P = 0.48). ATO, when added to ATRA or CTX/ATRA is feasible and effective in elderly patients for remission induction and consolidation, particularly in patients with high WBC at diagnosis.

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Conflict of interest statement

SK was supported by the Olympia-Morata fellowship program from the Medical Faculty of the Heidelberg University. MJL is supported by a grant from the NCI (NCI Leukemia SPORE P50 CA100632). UP has received research support from TEVA. All other authors declare no competing conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidence of relapse (CIR, a) and cumulative incidence of death (CID, b) according to treatment strategy. ATO arsenic trioxide, ATRA all-trans retinoic acid, CTX chemotherapy, n number.
Fig. 2
Fig. 2. Overall survival.
Overall survival of patients achieving a complete remission after induction therapy according to treatment strategy.
Fig. 3
Fig. 3. Cumulative incidence of relapse according to risk category and treatment.
a Cumulative incidence of relapse according to risk category (white blood cell count ≤10 × 109/l vs. >10 × 109/l) in patients treated with all-trans retinoic acid and chemotherapy. b Cumulative incidence of relapse according to risk category (white blood cell count ≤10 × 109/l vs. >10 × 109/l) in patients treated with arsenic trioxide-based regimens.
See this image and copyright information in PMC

References

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