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. 2022 Jul;37(4):841-850.
doi: 10.3904/kjim.2021.468. Epub 2022 Jun 28.

Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia

Young Hoon Park  1 , Dae-Young Kim  2 , Yeung-Chul Mun  1 , Eun Kyung Cho  3 , Jae Hoon Lee  3 , Deog-Yeon Jo  4 , Inho Kim  5 , Sung-Soo Yoon  5 , Seon Yang Park  5 , Byoungkook Kim  5 , Soo-Mee Bang  6 , Hawk Kim  7 , Young Joo Min  7 , Jae Hoo Park  7 , Jong Jin Seo  8 , Hyung Nam Moon  8 , Moon Hee Lee  9 , Chul Soo Kim  9 , Won Sik Lee  10 , So Young Chong  11 , Doyeun Oh  11 , Dae Young Zang  12 , Kyung Hee Lee  13 , Myung Soo Hyun  13 , Heung Sik Kim  14 , Sung-Hyun Kim  15 , Hyukchan Kwon  15 , Hyo Jin Kim  15 , Kyung Tae Park  16 , Sung Hwa Bae  17 , Hun Mo Ryoo  17 , Jung Hye Choi  18 , Myung-Ju Ahn  19 , Hwi-Joong Yoon  20 , Sung-Hyun Nam  21 , Bong-Seog Kim  21 , Chu-Myong Seong  1
Affiliations

Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia

Young Hoon Park et al. Korean J Intern Med. 2022 Jul.

Abstract

Background/aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL).

Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up.

Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis.

Conclusion: Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

Keywords: Cytarabine; Idarubicin; Leukemia, promyelocytic, acute; Tretinoin.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Consort diagram. CR, complete remission; TRM, treatment-related mortality; BMT, bone marrow transplantation.
Figure 2
Figure 2
Leukemia-free survival. CR, complete remission.
Figure 3
Figure 3
Overall survival. (A) Total. (B) Among patients who achieved complete remission.
Figure 4
Figure 4
Survival curves, according to the risk group, based on the initial white blood cell (WBC) count. (A) Leukemia-free survival. (B) Overall survival (total patients). (C) Overall survival (among patients who achieved complete remission [CR]).
Figure 5
Figure 5
Survival curves, according to the risk group, based on the initial white blood cell (WBC) and platelet counts. (A) Leukemia-free survival. (B) Overall survival (total patients). CR, complete remission.
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