Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide—an International Collaborative Study

Sabine Kayser, Ramy Rahmé, David Martínez-Cuadrón, Gabriel Ghiaur, Xavier Thomas, Marta Sobas, Agnes Guerci-Bresler, Ana Garrido, Arnaud Pigneux, Cristina Gil, Emmanuel Raffoux, Mar Tormo, Norbert Vey, Javier de la Serna, Olga Salamero, Eva Lengfelder, Mark J. Levis, Pierre Fenaux, Miguel A. Sanz, Uwe PlatzbeckerRichard F. Schlenk, Lionel Adès, Pau Montesinos

Research output: Contribution to journalArticle

Abstract

Data on outcome in older (≥70 years) patients with acute promyelocytic leukemia after treatment with arsenic trioxide (ATO) compared with standard chemotherapy (CTX) is scarce. We evaluated 433 patients (median age, 73.4 years) treated either with ATO+ all-trans retinoic acid (ATO/ATRA; n = 26), CTX/ATRA + ATO during consolidation (CTX/ATRA/ATO; n = 148), or with CTX/ATRA (n = 259). Median follow-up for overall survival (OS) was 4.8 years. Complete remissions (CR) were achieved in 92% with ATO/ATRA and 82% with CTX/ATRA; induction death rates were 8% and 18%, respectively. For analysis of postremission outcomes we combined the ATO/ATRA and CTX/ATRA/ATO groups (ATO/ATRA ± CTX). Cumulative incidence of relapse (CIR) was significantly lower after ATO/ATRA ± CTX compared with CTX/ATRA (P < 0.001). The same held true when restricting the analysis according to the treatment period after the year 2000. OS of patients in CR1 was not different between ATO/ATRA ± CTX compared with CTX/ATRA (P = 0.20). High (>10 × 109/l) white blood cell (WBC) counts at diagnosis were associated with higher CIR (P < 0.001) compared with lower WBC in the CTX/ATRA group, but not in the ATO/ATRA ± CTX group (P = 0.48). ATO, when added to ATRA or CTX/ATRA is feasible and effective in elderly patients for remission induction and consolidation, particularly in patients with high WBC at diagnosis.

Original languageEnglish (US)
JournalLeukemia
DOIs
StateAccepted/In press - Jan 1 2020

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Kayser, S., Rahmé, R., Martínez-Cuadrón, D., Ghiaur, G., Thomas, X., Sobas, M., Guerci-Bresler, A., Garrido, A., Pigneux, A., Gil, C., Raffoux, E., Tormo, M., Vey, N., de la Serna, J., Salamero, O., Lengfelder, E., Levis, M. J., Fenaux, P., Sanz, M. A., ... Montesinos, P. (Accepted/In press). Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide—an International Collaborative Study. Leukemia. https://doi.org/10.1038/s41375-020-0758-4