Positive Health Online

Abstract

LOU and COLLEAGUES,  (1)Department of Hematology, Institute of Hematology, The First Affiliated Hospital  of Zhejiang University, School of Medicine, Hangzhou, Zhejiang Province, China evaluated the efficacy of low-dose all-trans retinoic acid (ATRA) plus minimal chemotherapy for induction in newly diagnosed acute promyelocytic leukaemia (APL).

Background

The authors evaluated the efficacy of low-dose all-trans retinoic acid (ATRA) plus minimal chemotherapy for induction in newly diagnosed acute promyelocytic leukaemia (APL). Furthermore, we compared its long-term outcome with or without the addition of intravenous arsenic trioxide (ATO) in post-remission therapy.

Methodology

From January 2004 to September 2011, a total of 109 patients with a median age of 41 years (range 14-73) were enrolled in the study. Two arms were assigned according to post-remission protocols: ATO group cases were subsequently treated with intravenous ATO, standard chemotherapy, and ATRA. No-ATO group cases were subsequently treated with chemotherapy and ATRA only. Patients were monitored of minimal residual disease (MRD) by reverse-transcriptase polymerase chain reaction.

Results

The haematological complete remission (CR) rate was 96.3%. The early death rate was 0.9%. At a median follow-up of 49 months (range 8-102 months), the Kaplan-Meier estimates of 5-year relapse-free survival were significantly better for patients in the ATO group than in the no-ATO group, 94.4% vs 54.8% (p = 0.0001), and the 5-year overall survival rate was 95.7% vs 64.1%, in the two groups (p = 0.003).

Conclusion

These data show that low-dose ATRA plus minimal chemotherapy exhibits efficacy in induction therapy for untreated APL and suggest that the addition of ATO to post-remission therapy significantly improves the long-term outcome.

References

Lou Y(1), Qian W, Meng H, Mai W, Tong H, Tong Y, Huang J, Jin J. Long-term efficacy of low-dose all-trans retinoic acid plus minimal chemotherapy  induction followed by the addition of intravenous arsenic trioxide post-remission therapy in newly diagnosed acute promyelocytic leukaemia.  Hematol Oncol. 32(1):40-6. Mar 2014. doi: 10.1002/hon.2076. Epub Aug 20 2013.

Comment

The above clinical outcomes from Chinas in newly diagnosed promyelocytic leukaemia patients monitored by reverse-transcriptase polymerase chain reaction, demonstrated improvement in the 5-year overall survival rate and 5-year relapse-free survival with the addition of low-dose all-trans retinoic acid (ATRA) plus minimal chemotherapy followed by the addition of intravenous arsenic trioxide post-remission therapy.