Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab.

Abstract

The combination of all-trans-retinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of standard-risk patients with newly diagnosed acute promyelocytic leukemia (APL). A recent study demonstrated the efficacy of this regimen with added gemtuzumab ozogamicin (GO) in high-risk patients. We examined the long-term outcome of patients with newly diagnosed APL treated at our institution on 3 consecutive prospective clinical trials, using the combination of ATRA and ATO, with or without GO. For induction, all patients received ATRA (45 mg/m2 daily) and ATO (0.15 mg/kg daily) with a dose of GO (9 mg/m2 on day 1) added to high-risk patients (white blood cell count, >10 × 109/L), as well as low-risk patients who experienced leukocytosis during induction. Once in complete remission, patients received 4 cycles of ATRA plus ATO consolidation. One hundred eighty-seven patients, including 54 with high-risk and 133 with low-risk disease, have been treated. The complete remission rate was 96% (52 of 54 in high-risk and 127 of 133 in low-risk patients). Induction mortality was 4%, with only 7 relapses. Among low-risk patients, 60 patients (45%) required either GO or idarubicin for leukocytosis. Median duration of follow-up was 47.6 months. The 5-year event-free, disease-free, and overall survival rates are 85%, 96%, and 88%, respectively. Late hematological relapses beyond 1 year occurred in 3 patients. Fourteen deaths occurred beyond 1 year; 12 were related to other causes. This study confirms the durability of responses with this regimen.

• Authors: Yasmin Abaza, Hagop Kantarjian, Guillermo Garcia-Manero, Elihu Estey, Gautam Borthakur, Elias Jabbour, Stefan Faderl, Susan O'Brien, William Wierda, Sherry Pierce, Mark Brandt, Deborah McCue, Rajyalakshmi Luthra, Keyur Patel, Steven Kornblau, Tapan Kadia, Naval Daver, Courtney DiNardo, Nitin Jain, Srdan Verstovsek, Alessandra Ferrajoli, Michael Andreeff, Marina Konopleva, Zeev Estrov, Maria Foudray, David McCue, Jorge Cortes, Farhad Ravandi
• Journal: Blood (Blood) Vol. 129 Issue 10 Pg. 1275-1283 (03 09 2017) ISSN: 1528-0020 [Electronic] United States
• PMID: 28003274 (Publication Type: Clinical Trial, Journal Article)
• Copyright: © 2017 by The American Society of Hematology.

Chemical References

• Aminoglycosides
• Antibodies, Monoclonal, Humanized
• Arsenicals
• Oxides
• Tretinoin
• Gemtuzumab
• Arsenic Trioxide

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aminoglycosides (administration & dosage, adverse effects)
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Arsenic Trioxide
• Arsenicals (administration & dosage, adverse effects)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Gemtuzumab
• Humans
• Kaplan-Meier Estimate
• Leukemia, Promyelocytic, Acute (drug therapy, mortality)
• Male
• Middle Aged
• Oxides (administration & dosage, adverse effects)
• Polymerase Chain Reaction
• Treatment Outcome
• Tretinoin (administration & dosage, adverse effects)
• Young Adult