Abstract
Prolonged therapy with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) is highly effective in newly diagnosed acute promyelocytic leukemia (APL) but there is limited data on the efficacy of this regimen in the relapse setting. We report here on 22 APL patients treated with prolonged ATRA-ATO therapy at the time of disease relapse. Twenty patients obtained molecular complete remission (CRm) after 2 cycles (90%). Of these, two patients underwent hematopoietic stem cell transplant (HSCT) while the remaining proceeded to receive additional cycles (up to a total of 5) of ATRA-ATO. With a median follow-up of 58 months from the time of relapse (range: 21–128 months), the 4-year OS probability was 0.85 (95% CI 0.61–0.94), DFS was 0.74 (95% CI 0.49–0.88), and EFS 0.68 (95% CI 0.45–0.83). Two patients were resistant to ATRA-ATO salvage and five relapsed at a median of 19 months. Of these, four died due to progressive disease while three relapsed achieved a new CRm after further salvage therapy. This experience confirms the potentially curative effect of prolonged ATRA-ATO therapy in relapsed APL, especially in patients with long first complete remission.
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Funding
This study received financial support from Associazione Italiana Ricerca sul Cancro (AIRC, IG N. 5916 to FLC and fellowship 19738 LC) and from Associazione italiana contro le Leucemie-Linfomi e Mieloma (AIL).
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LC, MB, FLC, MM, MD, DD, MR, and MTV collected and analyzed the data; LC, FLC, and MB wrote the paper; MB, LC, and FLC designed the study; TO, VA, LI, DD, and MD collected and analyzed sample and revised the manuscript.
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LC received honorary for speaker’s bureau from TEVA; FLC and MB received honorary for speaker’s bureau and advisory board from TEVA.
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Cicconi, L., Breccia, M., Franceschini, L. et al. Prolonged treatment with arsenic trioxide (ATO) and all-trans-retinoic acid (ATRA) for relapsed acute promyelocytic leukemia previously treated with ATRA and chemotherapy. Ann Hematol 97, 1797–1802 (2018). https://doi.org/10.1007/s00277-018-3400-z
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DOI: https://doi.org/10.1007/s00277-018-3400-z