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Blood, 15 February 2004, Vol. 103, No. 4, pp. 1237-1243. Prepublished online as a Blood First Edition Paper on October 23, 2003; DOI 10.1182/blood-2003-07-2462. This Article Full Text (PDF) All Versions of this Article: 2003-07-2462v1 103/4/1237    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sanz, M. A Articles by Bolufer, P. Search for Related Content PubMed PubMed Citation Articles by Sanz, M. A Articles by Bolufer, P. Social Bookmarking                   What's this? Submitted July 21, 2003 Accepted October 12, 2003 Risk-adapted treatment of acute promyelocytic leukemia with all-trans retinoic acid and anthracycline monochemotherapy: a multicenter study by the PETHEMA Group Miguel A Sanz*, Guillermo Martin, Marcos Gonzalez, Angel Leon, Chelo Rayon, Concha Rivas, Dolors Colomer, Elena Amutio, Francisco J Capote, Gustavo A Milone, Javier de la Serna, Jose Roman, Eva Barragan, Juan Bergua, Lourdes Escoda, Ricardo Parody, Silvia Negri, Maria J Calasanz, and Pascual Bolufer Hematology Service, Hospital Universitario La Fe, Valencia, Spain Hematology Service, Hospital Universitario de Salamanca, Salamanca, Spain Hematology Service, Hospital General de Jerez, Jerez de la Frontera, Spain Hematology Service, Hospital Central de Asturias, Oviedo, Spain Hematology Service, Hospital General de Alicante, Alicante, Spain Hematology Service, Hospital Clinic, Barcelona, Spain Hematology Service, Hospital de Cruces, Baracaldo, Spain Hematology Service, Hospital Universitario Puerta del Mar, Cadiz, Spain Hematology Service, Fundaleu, Buenos Aires, Argentina Hematology Service, Hospital 12 de Octubre, Madrid, Spain Hematology Service, Hospital Reina Sofia, Cordoba, Spain Hematology Service, Hospital San Pedro de Alcantara, Caceres, Spain Hematology Service, Hospital Joan XXIII, Tarragona, Spain Hematology Service, Hospital Universitario Virgen del Rocio, Sevilla, Spain Hematology Service, Hospital Carlos Haya, Malaga, Spain Department of Genetics, Universidad de Navarra, Pamplona, Spain Department of Clinical Pathology, Hospital Universitario, Valencia, Spain * Corresponding author; email: msanz{at}uv.es. All-trans-retinoic acid (ATRA) increases the efficacy of chemotherapy when used for induction and maintenance treatment of acute promyelocytic leukemia (APL), but its role in consolidation is unknown. The Spanish cooperative group PETHEMA (Programa de Estudio y Tratamiento de las Hemopatias Malignas) approached this issue in a recent study. Since November 1996 (LPA96 study), 426 patients with newly diagnosed APL have received induction therapy with ATRA and idarubicin. Before November 1999, consolidation therapy consisted of three courses of anthracycline monochemotherapy. After November 1999 (LPA99 study), following a risk-adapted strategy, patients with intermediate and high risks of relapse defined by a simple predictive model received consolidation therapy with ATRA and increased doses of anthracyclines. Low-risk patients received the same consolidation as in the LPA96 trial. As maintenance therapy, all patients received mercaptopurine, methotrexate and ATRA. Of the 384 patients who achieved complete remission (90 percent), 382 proceeded to consolidation therapy. Seven patients died in remission (1.8 percent). The three-year cumulative incidence of relapse for patients in the LPA96 and LPA99 studies was 17.2 and 7.5 percent, respectively (P=0.008). Patients treated with ATRA in consolidation therapy showed an overall reduction in the relapse rate from 20.1 to 8.7 percent (P=0.004). In intermediate-risk patients the rate decreased from 14.0 to 2.5 percent (P= 0.006). This improved antileukemic efficacy also translated into significantly better disease-free and overall survival. A risk-adapted strategy combining anthracycline monochemotherapy and ATRA for induction and consolidation therapy of newly diagnosed APL results in improved antileukemic efficacy and a high degree of compliance. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: J. de la Serna, P. 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