Poor results with intensified maintenance chemotherapy in acute promyelocytic leukemia

2007 ◽  
Vol 4 (11) ◽  
pp. 617-618
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Maintenance Chemotherapy

A randomized study with or without intensified maintenance chemotherapy in patients with acute promyelocytic leukemia who have become negative for PML-RARα transcript after consolidation therapy: The Japan Adult Leukemia Study Group (JALSG) APL97 study

Blood ◽  
2007 ◽  
Vol 110 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Norio Asou ◽  
Yuji Kishimoto ◽  
Hitoshi Kiyoi ◽  
Masaya Okada ◽  
Yasukazu Kawai ◽  
...  
Keyword(s):  
Complete Remission ◽  
Acute Promyelocytic Leukemia ◽  
Randomized Study ◽  
Disease Free Survival ◽  
Promyelocytic Leukemia ◽  
Consolidation Therapy ◽  
Maintenance Chemotherapy ◽  
Free Survival ◽  
Significant Difference ◽  
Disease Free

To examine the efficacy of intensified maintenance chemotherapy, we conducted a prospective multicenter trial in adult patients with newly diagnosed acute promyelocytic leukemia treated with all-trans retinoic acid and chemotherapy. Of the 302 registered, 283 patients were assessable and 267 (94%) achieved complete remission. Predicted 6-year overall survival in all assessable patients and disease-free survival in patients who achieved complete remission were 83.9% and 68.5%, respectively. A total of 175 patients negative for PML-RARα at the end of consolidation were randomly assigned to receive either intensified maintenance chemotherapy (n = 89) or observation (n = 86). Predicted 6-year disease-free survival was 79.8% for the observation group and 63.1% for the chemotherapy group, showing no statistically significant difference between the 2 groups (P = .20). Predicted 6-year survival of patients assigned to the observation was 98.8%, which was significantly higher than 86.2% in those allocated to the intensified maintenance (P = .014). These results indicate that the intensified maintenance chemotherapy did not improve disease-free survival, but rather conferred a significantly poorer chance of survival in acute promyelocytic leukemia patients who have become negative for the PML-RARα fusion transcript after 3 courses of intensive consolidation therapy.

scholarly journals Role of maintenance chemotherapy in acute promyelocytic leukemia

Cancer ◽  
1987 ◽  
Vol 59 (7) ◽  
pp. 1258-1263 ◽  
Author(s):  
Hagop M. Kantarjian ◽  
Michael J. Keating ◽  
Ronald S. Walters ◽  
Terry L Smith ◽  
Kenneth B. McCredie ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Maintenance Chemotherapy

scholarly journals Maintenance Chemotherapy in Acute Promyelocytic Leukemia: The Thin Line Between Survival and Immunosuppression

2020 ◽  
Vol 4 (2) ◽  
pp. 01-03
Author(s):  
Sita Bhella ◽  
Catherine Maurice ◽  
Lili-Naz Hazrati ◽  
Robert Chen ◽  
Andre C Schuh ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia ◽  
Maintenance Chemotherapy ◽  
Thin Line

A Randomized Study with or without Intensified Maintenance Chemotherapy in Patients with Acute Promyelocytic Leukemia Who Had Become Negative for PML-RARα Transcript after Consolidation Therapy: The Japan Adult Leukemia Study Group (JALSG) APL97 Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2009-2009 ◽  
Author(s):  
Norio Asou ◽  
Yuji Kishimoto ◽  
Hitoshi Kiyoi ◽  
Masaya Okada ◽  
Yasukazu Kawai ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Maintenance Therapy ◽  
Acute Promyelocytic Leukemia ◽  
Fusion Transcript ◽  
Promyelocytic Leukemia ◽  
Term Therapy ◽  
Consolidation Therapy ◽  
Maintenance Chemotherapy ◽  
Hematopoietic Stem ◽  
Significant Difference

Abstract The use of all-trans retinoic acid (ATRA) has markedly improved therapeutic outcome in patients with acute promyelocytic leukemia (APL). Non-cross resistance between ATRA and chemotherapeutic drugs has contributed to not only a high complete remission (CR) rate but also a decrease in the relapse rate, leading to the significant improvement in disease-free survival (DFS) and overall survival (OS) rates. However, it is not clear whether maintenance chemotherapy actually prevents relapse in APL patients treated with ATRA and chemotherapy. If short-term therapy without maintenance shows identical DFS rates as compared to long-term therapy with maintenance, it would be beneficial for quality of life of patients as well as to medical costs. In these aspects, to determine an efficacy of maintenance/intensification chemotherapy, this study was designed to compare the DFS and OS rates in previously untreated adult patients with APL who showed absence of PML-RARα fusion transcript at the end of consolidation therapy and were randomly allocated to either maintenance therapy or observation. Of 302 registered, 283 patients were assessable and 267 (94%) achieved a CR. Predicted 6-year OS and DFS rates were 83.7% and 69.2%, respectively. The PML-RARα fusion gene was amplified using bone marrow samples at the diagnosis and after consolidation therapy by the reverse transcriptase-polymerase chain reaction analysis. The detection limit of PML-RARα fusion transcript in this assay was 10-4. Among 235 patients who completed 3 courses of consolidation chemotherapy, five (2.1%) were positive for the PML-RARα fusion transcript. Three of them subsequently relapsed and another one patient received allogeneic hematopoietic stem cell transplantation. On the other hand, 230 patients (97.9%) showed no PML-RARα transcript in the bone marrow cells at the end of consolidation. Of these, 175 patients were randomly assigned to receive moderately intensive and intermittent maintenance chemotherapy (n=89) or to observation (n=86). Predicted 6-year DFS was 63.2% for the chemotherapy group and 81.8% for the observation group, showing no statistically significant difference (p=0.102). Predicted 6-year OS in patients assigned to observation was 98.7% and was significantly higher than 85.9% in those allocated to maintenance therapy (p=0.013). These results indicate no benefit from adding maintenance chemotherapy in APL patients who are negative for PML-RARα fusion transcript after 3 courses of intensive consolidation.

scholarly journals Therapy-related myeloid neoplasms as a concerning complication in acute promyelocytic leukemia

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
María del Carmen Vicente-Ayuso ◽  
María García-Roa ◽  
Ataúlfo González-Fernández ◽  
Ana María Alvarez-Carmona ◽  
Celina Benavente-Cuesta ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Malignant Disease ◽  
Genetic Factors ◽  
Good Prognosis ◽  
Promyelocytic Leukemia ◽  
Maintenance Chemotherapy ◽  
Chemotherapy Treatment ◽  
Chemotherapy Induction ◽  
Myeloid Neoplasms ◽  
Original Clone

Acute promyelocytic leukemia (APL) has become a highly curable malignant disease after the introduction of all transretinoic acid (ATRA) to chemotherapy treatment. However, the risk to develop therapy-related myeloid neoplasms (t-MN) has become a matter of concern, as APL patients are otherwise expected to have a good prognosis. We report a patient with APL who achieved complete remission after chemotherapy induction with anthracycline and ATRA, followed by consolidation and maintenance chemotherapy. Two years later, the patient developed t-AML, with MLL rearrangements, without any evidence of relapse of the APL original clone. The increasing incidence of t-MN in oncohematological patients is partly due to the development of safer, more efficient or targeted therapies, which allow better outcomes and lengthened survival amongst treated patients. The identification of genetic factors, mechanisms or prognostic biomarkers in t-MN might open new windows for the development of personalized targeted therapy regimes in this underserved patient population.

Acute promyelocytic leukemia: Clinical and morphologic features and prognostic factors

2001 ◽  
Vol 38 (1) ◽  
pp. 4-12 ◽  
Author(s):  
Giuseppe Avvisati ◽  
Francesco Lo Coco ◽  
Franco Mandelli
Keyword(s):  
Prognostic Factors ◽  
Acute Promyelocytic Leukemia ◽  
Promyelocytic Leukemia
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