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Blood, 1 December 2004, Vol. 104, No. 12, pp. 3490-3493.
Prepublished online as a Blood First Edition Paper on August 3, 2004; DOI 10.1182/blood-2004-04-1642.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
All-trans retinoic acid and anthracycline monochemotherapy for the treatment of elderly patients with acute promyelocytic leukemia
Miguel A. Sanz,
Edo Vellenga,
Chelo Rayón,
Joaquín Díaz-Mediavilla,
Concha Rivas,
Elena Amutio,
Jesús Arias,
Guillermo Debén,
Andrés Novo,
Juan Bergua,
Javier de la Serna,
Javier Bueno,
Silvia Negri,
José M. Beltrán de Heredia, and
Guillermo Martín
From the Hospital Universitario La Fe, Valencia, Spain; University Hospital, Groningen, the Netherlands; Hospital Central de Asturias, Oviedo, Spain; Hospital Clínico San Carlos, Madrid, Spain; Hospital General, Alicante, Spain; Hospital de Cruces, Baracaldo, Spain; Complexo Hospitalario Xeral Calde, Lugo, Spain; Hospital Juan Canalejo, La Coruña, Spain; Hospital Son Dureta, Palma de Mallorca, Spain; Hospital San Pedro de Alcántara, Cáceres, Spain; Hospital 12 de Octubre, Madrid, Spain; Hospital Vall d'Hebron, Barcelona, Spain; Hospital Carlos Haya, Málaga, Spain; and Basurtuko Ospitalea, Basurto, Spain.
Therapeutic results in elderly patients with acute promyelocytic leukemia (APL) have been generally reported as less effective than for younger patients. Patients 60 years or older with APL who were enrolled in 2 successive multicenter PETHEMA studies received induction therapy with all-trans retinoic acid (ATRA) and idarubicin, consolidation with 3 anthracycline monochemotherapy courses with or without ATRA, and maintenance with ATRA and low-dose chemotherapy. Eighty-seven of 104 patients achieved complete remission (84%). Eighty-six proceeded to consolidation therapy (2 withdrew after the first and second courses). Deaths in remission occurred during consolidation and maintenance therapy in 3 and 4 patients, respectively. One patient showed molecular persistence after consolidation and 5 had a relapse. The 6-year cumulative incidence of relapse, leukemia-free survival, and disease-free survival were 8.5%, 91%, and 79%, respectively. A significantly higher incidence of low-risk patients found among the elderly, as compared to younger patients, may partially account for the low relapse rate observed. This study confirms the high antileukemic efficacy, low toxicity, and high degree of compliance of protocols using ATRA and anthracycline monochemotherapy for induction and consolidation therapy in elderly patients.
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