High efficacy and low toxicity of APL induction with concurrent idarubicin/ATRA followed by a novel and simplified outpatient post-remission therapy using single doses of idarubicin and intermittent ATRA

• Published in: Medical oncology (Northwood, London, England) Vol. 27; no. 3; pp. 702 - 707
• Main Authors: Aljurf, M., Al Qurashi, F., Al Mohareb, F., Sahovic, E., Al Sharif, F., Al Zahrani, H., Al Shanqeeti, A., Owaidah, T., Iqbal, A., Zaidi, S. Z. A., Nurgat, Z. A., Sanz, M., Chaudhri, N.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2010; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Ambulatory Care; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Clinical Trials as Topic - statistics & numerical data; Dexamethasone - administration & dosage; Disease-Free Survival; Drug Administration Schedule; Factor VIII - therapeutic use; Female; Fibrinogen - analysis; Fibrinogen - therapeutic use; Hematology; Hemorrhage - chemically induced; Hemorrhage - drug therapy; Humans; Idarubicin - administration & dosage; Idarubicin - adverse effects; Internal Medicine; Kaplan-Meier Estimate; Leukemia, Promyelocytic, Acute - drug therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Paper; Pathology; Pilot Projects; Remission Induction; Tretinoin - administration & dosage; Tretinoin - adverse effects; Young Adult; All; retinoic acid; Anthracyclines; Idarubicin; Acute promyelocytic leukemia
• ISSN: 1357-0560; 1559-131X
• DOI: 10.1007/s12032-009-9272-2

Acute promyelocytic leukemia (APL) is one of the most curable myeloid malignancies because of its great sensitivity to all-
trans
retinoic acid (ATRA) and response to anthracycline therapy. In an attempt to simplify post-remission therapy, deliver adequate dose of anthracycline and reduce treatment related toxicity, we entered 26 consecutively newly diagnosed, previously untreated APL patients in a pilot treatment program consisting of concurrent induction using idarubicin/ATRA followed by an exclusive outpatient post-remission therapy using single dose of idarubicin and intermittent ATRA, every 4 weeks. Of 25 evaluable patients, two (8%) died early during induction due to hemorrhagic complications, and 23 (92%) achieved complete remission. Overall survival at 4.2 years was 90% (CI 76.4–100), and 3.6 years disease-free survival was 78% (CI 60.6–95.4). The treatment outcome of this program is encouraging; however, the result of this study needs to be validated in larger cohort of patients and optimally in a randomized comparison with other current post-remission approaches.