TY - JOUR
T1 - Treatment of newly diagnosed acute promyelocytic leukemia (APL)
T2 - A comparison of French-Belgian-Swiss and PETHEMA results
AU - Adès, Lionel
AU - Sanz, Miguel A.
AU - Chevret, Sylvie
AU - Montesinos, Pau
AU - Chevallier, Patrice
AU - Raffoux, Emmanuel
AU - Vellenga, Edo
AU - Guerci, Agnès
AU - Pigneux, Arnaud
AU - Huguet, Francoise
AU - Rayon, Consuelo
AU - Stoppa, Anne Marie
AU - De La Serna, Javier
AU - Cahn, Jean Yves
AU - Meyer-Monard, Sandrine
AU - Pabst, Thomas
AU - Thomas, Xavier
AU - De Botton, Stéphane
AU - Parody, Ricardo
AU - Bergua, Juan
AU - Lamy, Thierry
AU - Vekhoff, Anne
AU - Negri, Silvia
AU - Ifrah, Norbert
AU - Dombret, Hervé
AU - Ferrant, Augustin
AU - Bron, Dominique
AU - Degos, Laurent
AU - Fenaux, Pierre
PY - 2008/1/1
Y1 - 2008/1/1
N2 - All-trans retinoic acid (ATRA) plus anthracycline chemotherapy is the reference treatment of newly diagnosed acute promyelocytic leukemia (APL), whereas the role of cytosine arabinoside (AraC) remains disputed. We performed a joint analysis of patients younger than 65 years included in Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA) LPA 99 trial, where patients received no AraC in addition to ATRA, high cumulative dose idarubicin, and mitoxantrone, and APL 2000 trial, where patients received AraC in addition to ATRA and lower cumulative dose daunorubicin. In patients with white blood cell (WBC) count less than 10 × 109/L, complete remission (CR) rates were similar, but 3-year cumulative incidence of relapse (CIR) was significantly lower in LPA 99 trial: 4.2% versus 14.3% (P = .03), although 3-year survival was similar in both trials. This suggested that AraC is not required in APL with WBC count less than 10 × 109/L, at least in trials with high-dose anthracycline and maintenance treatment. In patients with WBC of 10 × 109/L or more, however, the CR rate (95.1% vs 83.6% P = .018) and 3-year survival (91.5% vs 80.8%, P = .026) were significantly higher in APL 2000 trial, and there was a trend for lower 3-year CIR (9.9% vs 18.5%, P = .12), suggesting a beneficial role for AraC in those patients.
AB - All-trans retinoic acid (ATRA) plus anthracycline chemotherapy is the reference treatment of newly diagnosed acute promyelocytic leukemia (APL), whereas the role of cytosine arabinoside (AraC) remains disputed. We performed a joint analysis of patients younger than 65 years included in Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA) LPA 99 trial, where patients received no AraC in addition to ATRA, high cumulative dose idarubicin, and mitoxantrone, and APL 2000 trial, where patients received AraC in addition to ATRA and lower cumulative dose daunorubicin. In patients with white blood cell (WBC) count less than 10 × 109/L, complete remission (CR) rates were similar, but 3-year cumulative incidence of relapse (CIR) was significantly lower in LPA 99 trial: 4.2% versus 14.3% (P = .03), although 3-year survival was similar in both trials. This suggested that AraC is not required in APL with WBC count less than 10 × 109/L, at least in trials with high-dose anthracycline and maintenance treatment. In patients with WBC of 10 × 109/L or more, however, the CR rate (95.1% vs 83.6% P = .018) and 3-year survival (91.5% vs 80.8%, P = .026) were significantly higher in APL 2000 trial, and there was a trend for lower 3-year CIR (9.9% vs 18.5%, P = .12), suggesting a beneficial role for AraC in those patients.
UR - http://www.scopus.com/inward/record.url?scp=38949092914&partnerID=8YFLogxK
U2 - 10.1182/blood-2007-07-099978
DO - 10.1182/blood-2007-07-099978
M3 - Article
C2 - 17975017
AN - SCOPUS:38949092914
SN - 0006-4971
VL - 111
SP - 1078
EP - 1084
JO - Blood
JF - Blood
IS - 3
ER -