Early Death and Survival of Patients With Acute Promyelocytic Leukemia in ATRA Plus Arsenic Era: A Population-Based Study.

Abstract

Most randomized trials for acute promyelocytic leukemia (APL) have investigated highly selected patients under idealized conditions, and the findings need to be validated in the real world. We conducted a population-based study of all APL patients in Zhejiang Province, China, with a total population of 82 million people, to assess the generalization of all-trans retinoic acid (ATRA) and arsenic as front-line treatment. The outcomes of APL patients were also analyzed. Between January 2015 and December 2019, 1,233 eligible patients were included in the final analysis. The rate of ATRA and arsenic as front-line treatment increased steadily from 66.2% in 2015 to 83.3% in 2019, with no difference among the size of the center (≥5 or <5 patients per year, p = 0.12) or age (≥60 or <60 years, p = 0.35). The early death (ED) rate, defined as death within 30 days after diagnosis, was 8.2%, and the 3-year overall survival (OS) was 87.9% in the whole patient population. Age (≥60 years) and white blood cell count (>10 × 109/L) were independent risk factors for ED and OS in the multivariate analysis. This population-based study showed that ATRA and arsenic as front-line treatment are widely used under real-world conditions and yield a low ED rate and a high survival rate, which mimic the results from clinical trials, thereby supporting the wider application of APL guidelines in the future.

• Authors: Hong-Hu Zhu, Ya-Fang Ma, Kang Yu, Gui-Fang Ouyang, Wen-Da Luo, Ren-Zhi Pei, Wei-Qun Xu, Hui-Xian Hu, Shu-Ping Mo, Xiao-Hua Xu, Jian-Ping Lan, Jian-Ping Shen, Li-Hong Shou, Shen-Xian Qian, Wei-Ying Feng, Pu Zhao, Jin-Hong Jiang, Bei-Li Hu, Jin Zhang, Su-Ying Qian, Gong-Qiang Wu, Wen-Ping Wu, Lei Qiu, Lin-Jie Li, Xiang-Hua Lang, Sai Chen, Li-Li Chen, Jun-Bin Guo, Li-Hong Cao, Hui-Fang Jiang, Yong-Ming Xia, Jing Le, Jian-Zhi Zhao, Jian Huang, Yue-Feng Zhang, Ya-Li Lv, Jing-Sheng Hua, Yong-Wei Hong, Cui-Ping Zheng, Ju-Xiang Wang, Bin-Fei Hu, Xiao-Hui Chen, Li-Ming Zhang, Shi Tao, Bing-Shou Xie, Yue-Min Kuang, Wen-Ji Luo, Ping Su, Jun Guo, Xiao Wu, Wei Jiang, Hui-Qi Zhang, Yun Zhang, Chun-Mei Chen, Xiao-Feng Xu, Yan Guo, Jin-Ming Tu, Shao Hu, Xiao-Yan Yan, Chen Yao, Yin-Jun Lou, Jie Jin, APL Cooperative Group of Zhejiang Province
• Journal: Frontiers in oncology (Front Oncol) Vol. 11 Pg. 762653 ( 2021) ISSN: 2234-943X [Print] Switzerland
• PMID: 34868978 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Zhu, Ma, Yu, Ouyang, Luo, Pei, Xu, Hu, Mo, Xu, Lan, Shen, Shou, Qian, Feng, Zhao, Jiang, Hu, Zhang, Qian, Wu, Wu, Qiu, Li, Lang, Chen, Chen, Guo, Cao, Jiang, Xia, Le, Zhao, Huang, Zhang, Lv, Hua, Hong, Zheng, Wang, Hu, Chen, Zhang, Tao, Xie, Kuang, Luo, Su, Guo, Wu, Jiang, Zhang, Zhang, Chen, Xu, Guo, Tu, Hu, Yan, Yao, Lou, Jin and the APL Cooperative Group of Zhejiang Province.