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

• Published in: Leukemia Vol. 34; no. 9; pp. 2333 - 2341
• Main Authors: Kayser, Sabine, Rahmé, Ramy, Martínez-Cuadrón, David, Ghiaur, Gabriel, Thomas, Xavier, Sobas, Marta, Guerci-Bresler, Agnes, Garrido, Ana, Pigneux, Arnaud, Gil, Cristina, Raffoux, Emmanuel, Tormo, Mar, Vey, Norbert, de la Serna, Javier, Salamero, Olga, Lengfelder, Eva, Levis, Mark J., Fenaux, Pierre, Sanz, Miguel A., Platzbecker, Uwe, Schlenk, Richard F., Adès, Lionel, Montesinos, Pau
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-09-2020; Nature Publishing Group
• Subjects: 631/208/2489; 692/699/1541/1990/283/1897; Acute promyeloid leukemia; Aged; Aged, 80 and over; Analysis; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Arsenic; Arsenic trioxide; Arsenic Trioxide - administration & dosage; Arsenic Trioxide - therapeutic use; Blood cell count; Cancer; Cancer Research; Chemotherapy; Consolidation; Critical Care Medicine; Diagnosis; Female; Hematology; Humans; Intensive; Internal Medicine; International Cooperation; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - genetics; Leukocytes; Male; Medicine; Medicine & Public Health; Oncology; Promyeloid leukemia; Remission; Remission Induction; Retinoic acid; Treatment Outcome; Tretinoin
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/s41375-020-0758-4

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 × 10
9
/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.