Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy

D. Martínez-Cuadrón, P. Montesinos, E. Vellenga, T. Bernal, O. Salamero, A. Holowiecka, S. Brunet, C. Gil, C. Benavente, J. M. Ribera, M. Pérez-Encinas, J. De La Serna, J. Esteve, V. Rubio, J. González-Campos, L. Escoda, M. E. Amutio, M. Arnan, J. Arias, S. NegriB. Lowënberg, M. A. Sanz

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11 Citations (Scopus)

Abstract

© 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.
Original languageEnglish
Pages (from-to)21-29
JournalLeukemia
Volume32
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

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    Martínez-Cuadrón, D., Montesinos, P., Vellenga, E., Bernal, T., Salamero, O., Holowiecka, A., Brunet, S., Gil, C., Benavente, C., Ribera, J. M., Pérez-Encinas, M., De La Serna, J., Esteve, J., Rubio, V., González-Campos, J., Escoda, L., Amutio, M. E., Arnan, M., Arias, J., ... Sanz, M. A. (2018). 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. https://doi.org/10.1038/leu.2017.178