TY - JOUR
T1 - Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy
AU - Martínez-Cuadrón, D.
AU - Montesinos, P.
AU - Vellenga, E.
AU - Bernal, T.
AU - Salamero, O.
AU - Holowiecka, A.
AU - Brunet, S.
AU - Gil, C.
AU - Benavente, C.
AU - Ribera, J. M.
AU - Pérez-Encinas, M.
AU - De La Serna, J.
AU - Esteve, J.
AU - Rubio, V.
AU - González-Campos, J.
AU - Escoda, L.
AU - Amutio, M. E.
AU - Arnan, M.
AU - Arias, J.
AU - Negri, S.
AU - Lowënberg, B.
AU - Sanz, M. A.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - © 2018 Macmillan Publishers Limited. 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 postremission non-relapse mortality (NRM). 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). 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. 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.
AB - © 2018 Macmillan Publishers Limited. 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 postremission non-relapse mortality (NRM). 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). 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. 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.
U2 - 10.1038/leu.2017.178
DO - 10.1038/leu.2017.178
M3 - Article
C2 - 28584252
SN - 0887-6924
VL - 32
SP - 21
EP - 29
JO - Leukemia
JF - Leukemia
IS - 1
ER -