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Incorporation of arsenic trioxide in induction therapy improves survival of patients with newly diagnosed acute promyelocytic leukaemia
Author(s) -
Song Xianmin,
Hu Xiaoxia,
Lü Shuqing,
Gao Lei,
Chen Li,
Yang Jianmin,
Zhang Weiping,
Wang Jianmin
Publication year - 2014
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12301
Subject(s) - arsenic trioxide , acute promyelocytic leukemia , medicine , daunorubicin , anthracycline , regimen , retinoic acid , tretinoin , oncology , maintenance therapy , gastroenterology , chemotherapy , immunology , apoptosis , cancer , biology , biochemistry , breast cancer , gene
Objectives For patients with acute promyelocytic leukaemia ( APL ), negative reading of a promyelocytic leukaemia/retinoic acid receptor‐alpha ( PML ‐ RAR α ) transcript after induction therapy correlates with a good prognosis. However, in the majority of patients given all‐ trans retinoic acid ( ATRA )/anthracycline‐based induction therapy, PML ‐ RAR α transcript remains even when haematologic complete remission is achieved. To facilitate maximal therapeutic efficacy for patients with APL , this study tested whether the addition of arsenic trioxide ( ATO ) would increase the rate of molecular complete remission after ATRA /anthracycline‐based induction therapy. Methods Seventy‐three patients with APL were induced with a regimen (designated ‘ AAA ’) consisting of ATO in combination with ATRA and daunorubicin. After this, a consolidation phase of daunorubicin‐based chemotherapy and maintenance therapy with ATRA , ATO and methotrexate was administered. The noted outcomes were rates of complete remission, overall survival and disease‐free survival. In addition, PML ‐ RAR α transcripts were monitored in 48 patients via RT ‐ PCR . Results Rates of complete remission, overall survival and 5‐yr disease‐free survival were 95.89%, 94.52% and 96.28%, respectively. At the preconsolidation checkpoint, 68.75% (33/48) of patients had a negative reading for the PML ‐ RAR α fusion transcript. These outcomes were not influenced by mutations in FLT 3 (fms‐related tyrosine kinase 3) or other prognostic factors. Conclusions The addition of ATO in the induction regimen was associated with an improved overall outcome for patients with de novo APL , with rather low relapse rate and better long‐term survival.