Evaluation of the efficacy of maintenance therapy for low-to-intermediate-risk acute promyelocytic leukemia in molecular remission: A retrospective single-institution study
- Authors:
- Masahide Yamamoto
- Keigo Okada
- Hiroki Akiyama
- Tetsuya Kurosu
- Osamu Miura
View Affiliations
Affiliations: Department of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113‑8519, Japan
- Published online on: December 10, 2014 https://doi.org/10.3892/mco.2014.476
-
Pages:
449-453
Metrics: Total
Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
This article is mentioned in:
Abstract
The prognosis of acute promyelocytic leukemia (APL) has become the most favorable among all acute myeloid leukemias, due to the efficacy of treatment with all‑trans retinoic acid (ATRA). ATRA combined with anthracycline‑based chemotherapy has significantly improved the long‑term outcome for low‑to‑intermediate‑risk APL patients; thus, the efficacy of maintenance therapy for patients achieving molecular complete remission (MCR) following consolidation therapy has become debatable. To evaluate the efficacy of maintenance therapy, we conducted a retrospective analysis of 11 consecutive patients with low‑to‑intermediate‑risk APL who received induction and consolidation therapy with ATRA and anthracyclines according to the PETHEMA LPA protocols at our hospital between January, 2001 and March, 2013. All the patients achieved MCR following consolidation therapy. Of these patients, 7 were followed without maintenance therapy, including 2 patients who discontinued maintenance therapy within 2 months. With a median follow‑up of 85 months, the overall survival for all the patients was 100%, while the disease‑free survival estimate at 5 years with and without maintenance therapy was 100 and 85.7%, respectively; the difference was not statistically significant (P=0.45). Two patients treated with maintenance therapy later developed secondary primary malignancy. Thus, even without maintenance therapy, ATRA combined with anthracyclines exhibited significant efficacy in low‑to‑intermediate‑risk APL patients, suggesting that maintenance therapy, which is associated with adverse events, may be dispensable for patients achieving MCR following adequate consolidation therapy.
View References
|
1
|
Elbahesh E, Patel N and Tabbara IA:
Treatment of acute promyelocytic leukemia. Anticancer Res.
34:1507–1517. 2014.PubMed/NCBI
|
|
2
|
Sanz MA, Montesinos P, Rayon C, et al
PETHEMA and HOVON Groups: Risk-adapted treatment of acute
promyelocytic leukemia based on all-trans retinoic acid and
anthracycline with addition of cytarabine in consolidation therapy
for high-risk patients: further improvements in treatment outcome.
Blood. 115:5137–5146. 2010. View Article : Google Scholar : PubMed/NCBI
|
|
3
|
Avvisati G, Lo-Coco F, Paoloni FP, et al
GIMEMA AIEOP EORTC Cooperative Groups: AIDA 0493 protocol for newly
diagnosed acute promyelocytic leukemia: very long-term results and
role of maintenance. Blood. 117:4716–4725. 2011. View Article : Google Scholar : PubMed/NCBI
|
|
4
|
Lo-Coco F, Avvisati G, Vignetti M, et al
Gruppo Italiano Malattie Ematologiche dell'Adulto; German-Austrian
Acute Myeloid Leukemia Study Group; Study Alliance Leukemia:
Retinoic acid and arsenic trioxide for acute promyelocytic
leukemia. N Engl J Med. 369:111–121. 2013. View Article : Google Scholar : PubMed/NCBI
|
|
5
|
Sanz MA, Martin G, Rayon C, et al: A
modified AIDA protocol with anthracycline-based consolidation
results in high antileukemic efficacy and reduced toxicity in newly
diagnosed PML/RARalpha-positive acute promyelocytic leukemia.
PETHEMA group. Blood. 94:3015–3021. 1999.PubMed/NCBI
|
|
6
|
Sanz MA, Lo Coco F, Martin G, et al:
Definition of relapse risk and role of nonanthracycline drugs for
consolidation in patients with acute promyelocytic leukemia: a
joint study of the PETHEMA and GIMEMA cooperative groups. Blood.
96:1247–1253. 2000.PubMed/NCBI
|
|
7
|
Kanda Y: Investigation of the freely
available easy-to-use software ‘EZR’ for medical statistics. Bone
Marrow Transplant. 48:452–458. 2013. View Article : Google Scholar : PubMed/NCBI
|
|
8
|
Tallman MS, Andersen JW, Schiffer CA, et
al: All-trans-retinoic acid in acute promyelocytic leukemia. N Engl
J Med. 337:1021–1028. 1997. View Article : Google Scholar : PubMed/NCBI
|
|
9
|
Fenaux P, Chastang C, Chevret S, et al: A
randomized comparison of all transretinoic acid (ATRA) followed by
chemotherapy and ATRA plus chemotherapy and the role of maintenance
therapy in newly diagnosed acute promyelocytic leukemia. The
European APL Group. Blood. 94:1192–1200. 1999.PubMed/NCBI
|
|
10
|
Tallman MS, Andersen JW, Schiffer CA, et
al: All-trans retinoic acid in acute promyelocytic leukemia:
long-term outcome and prognostic factor analysis from the North
American Intergroup protocol. Blood. 100:4298–4302. 2002.
View Article : Google Scholar : PubMed/NCBI
|
|
11
|
Ades L, Guerci A, Raffoux E, et al
European APL Group: Very long-term outcome of acute promyelocytic
leukemia after treatment with all-trans retinoic acid and
chemotherapy: the European APL Group experience. Blood.
115:1690–1696. 2010. View Article : Google Scholar : PubMed/NCBI
|
|
12
|
Coutre SE, Othus M, Powell B, et al:
Arsenic trioxide during consolidation for patients with previously
untreated low/intermediate risk acute promyelocytic leukaemia may
eliminate the need for maintenance therapy. Br J Haematol.
165:497–503. 2014. View Article : Google Scholar : PubMed/NCBI
|
|
13
|
Asou N, Kishimoto Y, Kiyoi H, et al the
Japan Adult Leukemia Study Group: A randomized study with or
without intensified maintenance chemotherapy in patients with acute
promyelocytic leukemia who have become negative for PML-RARalpha
transcript after consolidation therapy: the Japan Adult Leukemia
Study Group (JALSG) AP197 study. Blood. 110:59–66. 2007. View Article : Google Scholar : PubMed/NCBI
|
