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Leukemia. 2018 Jan;32(1):21-29. doi: 10.1038/leu.2017.178. Epub 2017 Jun 6.

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

Author information

1
Hospital Universitari i Politècnic La Fe, Valencia, Spain.
2
CIBERONC, Instituto Carlos III, Madrid, Spain.
3
University Hospital, Groningen, The Netherlands.
4
Hospital Central de Asturias, Oviedo, Spain.
5
Hospital Universitario Vall d´Hebron, Barcelona, Spain.
6
Silesian Medical University, Katowice, Poland.
7
Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
8
Hospital General, Alicante, Spain.
9
Hospital Clínico San Carlos, Madrid, Spain.
10
ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain.
11
Hospital Clínico, Santiago de Compostela, Spain.
12
Hospital 12 de Octubre, Madrid, Spain.
13
Hospital Clinic, Barcelona, Spain.
14
Hospital General, Jerez de la Frontera, Spain.
15
Hospital Universitario Virgen del Rocío, Sevilla, Spain.
16
Hospital Joan XXIII, Tarragona, Spain.
17
Hospital Universitario Cruces, Bizkaia, Spain.
18
ICO-Hospital Duran i Reynals, Hospitalet del Llobregat, Spain.
19
Hospital Universitario Lucus Augusti, Lugo, Spain.
20
Hospital Regional Universitario Carlos Haya, Málaga, Spain.
21
Erasmus University Medical Center, Rotterdam, The Netherlands.
22
Department of Medicine, University of Valencia, Valencia, Spain.

Abstract

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00408278.

PMID:
28584252
DOI:
10.1038/leu.2017.178
[Indexed for MEDLINE]

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