Positive Health Online

Abstract

MARTÍNEZ-CUADRÓN and COLLLEAGUES,1 Hospital Universitari i Politècnic La Fe, Valencia, Spain;  2 CIBERONC, Instituto Carlos III, Madrid, Spain; 3 University Hospital, Groningen, The Netherlands;         4 Hospital Central de Asturias, Oviedo, Spain; 5 Hospital Universitario Vall d´Hebron, Barcelona, Spain; 6 Silesian Medical University, Katowice, Poland; 7 Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; •            8 Hospital General, Alicante, Spain; 9 Hospital Clínico San Carlos, Madrid, Spain; 10 ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain; 11 Hospital Clínico, Santiago de Compostela, Spain; 12 Hospital 12 de Octubre, Madrid, Spain; 13 Hospital Clinic, Barcelona, Spain; 14 Hospital General, Jerez de la Frontera, Spain;15 Hospital Universitario Virgen del Rocío, Sevilla, Spain; 16 Hospital Joan XXIII, Tarragona, Spain; 17 Hospital Universitario Cruces, Bizkaia, Spain; 18 ICO-Hospital Duran i Reynals, Hospitalet del Llobregat, Spain;19 Hospital Universitario Lucus Augusti, Lugo, Spain;            20 Hospital Regional Universitario Carlos Haya, Málaga, Spain; 21 Erasmus University Medical Center, Rotterdam, The Netherlands; 22 Department of Medicine, University of Valencia, Valencia, Spain treated older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based chemotherapy. 

Background

Treatment outcome in older patients with acute promyelocytic leukemia (APL) is lower compared with younger patients, mainly because of a higher induction death rate and post remission non-relapse mortality (NRM).

Methodology

This prompted us to design a risk- and age-adapted protocol (Programa Español de Tratamientos en Hematología (PETHEMA)/HOVON LPA2005), with dose reduction of consolidation chemotherapy. Patients aged ⩾60 years reported to the PETHEMA registry and were treated with all-trans retinoic acid (ATRA) plus anthracycline-based regimens according to three consecutive PETHEMA trials that were included. We compared the long-term outcomes of the LPA2005 trial with the preceding PETHEMA trials using non-age-adapted schedules (LPA96&LPA99).

Results

From 1996 to 2012, 389 older patients were registered, of whom 268 patients (69%) were eligible. Causes of ineligibility were secondary APL (19%), and unfit for chemotherapy (11%). Median age was 67 years, without relevant differences between LPA2005 and LPA96&LPA99 cohorts. Overall, 216 patients (81%) achieved complete remission with no differences between trials.

Conclusion

The 5-year NRM, cumulative incidence of relapse, disease-free survival and overall survival in the LPA2005 vs the LPA96&99 were 5 vs 18% (P=0.15), 7 vs 12% (P=0.23), 87 vs 69% (P=0.04) and 74 vs 60% (P=0.06). A less intensive front-line regimen with ATRA and anthracycline monochemotherapy resulted in improved outcomes in older APL patients. Trial registration: ClinicalTrials.gov NCT00408278.

References

D Martínez-Cuadrón  1   2 , P Montesinos  1   2 , E Vellenga  3 , T Bernal  4 , O Salamero  5 , A Holowiecka  6 , S Brunet  7 , C Gil  8 , C Benavente  9 , J M Ribera  10 , M Pérez-Encinas  11 , J De la Serna  12 , J Esteve  13 , V Rubio  14 , J González-Campos  15 , L Escoda  16 , M E Amutio  17 , M Arnan  18 , J Arias  19 , S Negri  20 , B Lowënberg  21 , M A Sanz  1   2   22. Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy  Leukemia; 32(1):21-29. doi: 10.1038/leu.2017.178. Epub Jun 6 2017.  Jan 2018.