Treatment of Acute Promyelocytic Leukemia (APL) by a Combination of All-Trans Retinoic Acid (ATRA) and Chemotherapy.
- Author:
Je Jung LEE
1
;
Jeong Rae BYUN
;
Sang Yong KWON
;
Moo Rim PARK
;
Kyeoung Sang CHOI
;
Sung Chul LIM
;
Ik Joo CHUNG
;
Hyeoung Joon KIM
Author Information
1. Department of Internal Medicine, Chonnam University Medical School, Kwangju, Korea.
- Publication Type:Original Article
- Keywords:
All-trans retinoic acid (ATRA);
Acute promyelocytic leukemia (APL);
Chemotherapy
- MeSH:
Bone Marrow Transplantation;
Cerebral Hemorrhage;
Disease-Free Survival;
Drug Therapy*;
Drug Therapy, Combination;
Follow-Up Studies;
Humans;
Jeollanam-do;
Leukemia, Promyelocytic, Acute*;
Leukocytes;
Mortality;
Recurrence;
Tretinoin*
- From:Korean Journal of Hematology
1998;33(3):363-371
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: All-trans-retinoic acid (ATRA) induces complete remission (CR) in the great majority of patients with PML/RAR -positive acute promyelocytic leukemia (APL). However, it is associated with a rapid rise in leukocytes in one third to half the patients, with potentially fatal "ATRA syndrome". Furthermore, most of the patients relapse with maintenance therapy using ATRA alone or low-dose chemotherapy. In this study, we have analyzed the outcome for APL patients who were treated with ATRA alone or combined with low-dose chemotherapy followed by postremission chemotherapy in Chonnam University Hospital from April 1993 to December 1997. METHODS: Sixteen patients with newly diagnosed APL were eligible to analysis. Patients received 45mg/m2 ATRA until CR occurred. If initial WBC were above 5,000/microliter, low-dose chemotherapy was concomitantly given, and if during the ATRA therapy WBC were above 5,000/microliter by day 5 or 10,000/microliter by day 10, or 15,000/microliter by day 15, low-dose chemotherapy was added. Four polychemotherapy cycles or allogeneic bone marrow transplantation were given as postremission therapy. RESULTS: Median age was 34 years (range, 17 to 67). Of 16 APL patients, 15 (93.8%) achieved CR and 1 (6.2%) died of intracerebral hemorrhage. After a median follow-up of 11.5 months (range, 0 to 47), the Kaplan-Meier estimated overall survival (OS) rate was 87.1 +/- 8.6% at 3 year, the event-free survival (EFS) rate was 87.1 +/- 8.6%, 58.0 +/- 24.4% and 29.0 +/- 23.9% at 1 year, 2 year and 3 year, and the disease-free survival (DFS) rate was 92.9 +/- 6.9%, 69.6 +/- 20.7% and 46.4 +/- 23.5% at 1 year, 2 year and 3 year, respectively. CONCLUSION: The present study suggests that ATRA with or without low-dose chemotherapy followed by postremission chemotherapy is a well-tolerated and effective regimen that is shown to improve the CR rate, reduce a early mortality rate and considerably prolong the overall survival in patients with newly diagnosed APL.
