Tags

Type your tag names separated by a space and hit enter

Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long-term results and unique prognostic indicators.
Cancer. 2020 Jul 15; 126(14):3244-3254.C

Abstract

BACKGROUND

The role of arsenic trioxide (As2 O3) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear.

METHODS

A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all-trans retinoic acid [ATRA]/daunorubicin) and consolidation (daunorubicin/cytarabine [induction daunorubicin and consolidation omitted for age ≥70 years]) underwent maintenance comprising ATRA (45 mg/m2 /day), oral As2 O3 (10 mg/day), and ascorbic acid (1 g/day) (AAA) for 2 weeks every 2 months for 2 years.

RESULTS

Over a 17-year period from August 1, 2002, to July 31, 2019, 63 men and 66 women (median age, 46 years [range, 18-82 years]) received AAA maintenance, which was already completed in 117 patients. At a median follow-up of 100 months (range, 8-215 months), 17 patients (13%) developed first relapse (R1) (hematologic, n = 14; molecular, n = 3) after a median of 19 months (range, 7-96 months) from CR1. Two R1 patients had concomitant central nervous system (CNS) involvement. All patients achieved CR2 with oral As2 O3 -based salvage. Five patients had a subsequent relapse and died. Eight patients died of unrelated causes while still in CR1. The 5-year and 10-year rates of relapse-free survival (RFS) were 89% and 85%, respectively. The 5-year and 10-year rates of overall survival (OS) were 94% and 87%, respectively. Multivariate analysis showed that inferior RFS was associated with FLT3-ITD (P = .005) and CNS involvement on presentation (P = .004), and inferior OS was associated with therapy-related APL (P = .03), FLT3-ITD (P = .03), and relapse (P = .03). The safety profile was favorable, with no grade 3/4 organ toxicities.

CONCLUSION

CR1 maintenance with AAA is safe and results in favorable long-term survival in patients with APL.

Authors+Show Affiliations

Department of Medicine, University of Hong Kong, Hong Kong, China.Department of Medicine, University of Hong Kong, Hong Kong, China.Department of Medicine, University of Hong Kong, Hong Kong, China.Department of Medicine, University of Hong Kong, Hong Kong, China.Department of Medicine, University of Hong Kong, Hong Kong, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32365228

Citation

Gill, Harinder S., et al. "Oral Arsenic Trioxide, All-trans Retinoic Acid, and Ascorbic Acid Maintenance After First Complete Remission in Acute Promyelocytic Leukemia: Long-term Results and Unique Prognostic Indicators." Cancer, vol. 126, no. 14, 2020, pp. 3244-3254.
Gill HS, Yim R, Kumana CR, et al. Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long-term results and unique prognostic indicators. Cancer. 2020;126(14):3244-3254.
Gill, H. S., Yim, R., Kumana, C. R., Tse, E., & Kwong, Y. L. (2020). Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long-term results and unique prognostic indicators. Cancer, 126(14), 3244-3254. https://doi.org/10.1002/cncr.32937
Gill HS, et al. Oral Arsenic Trioxide, All-trans Retinoic Acid, and Ascorbic Acid Maintenance After First Complete Remission in Acute Promyelocytic Leukemia: Long-term Results and Unique Prognostic Indicators. Cancer. 2020 Jul 15;126(14):3244-3254. PubMed PMID: 32365228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral arsenic trioxide, all-trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long-term results and unique prognostic indicators. AU - Gill,Harinder S, AU - Yim,Rita, AU - Kumana,Cyrus R, AU - Tse,Eric, AU - Kwong,Yok-Lam, Y1 - 2020/05/04/ PY - 2020/02/26/received PY - 2020/04/04/revised PY - 2020/04/06/accepted PY - 2020/5/5/pubmed PY - 2020/5/5/medline PY - 2020/5/5/entrez KW - acute promyelocytic leukemia KW - arsenic trioxide KW - first completion remission KW - maintenance KW - oral SP - 3244 EP - 3254 JF - Cancer JO - Cancer VL - 126 IS - 14 N2 - BACKGROUND: The role of arsenic trioxide (As2 O3) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear. METHODS: A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all-trans retinoic acid [ATRA]/daunorubicin) and consolidation (daunorubicin/cytarabine [induction daunorubicin and consolidation omitted for age ≥70 years]) underwent maintenance comprising ATRA (45 mg/m2 /day), oral As2 O3 (10 mg/day), and ascorbic acid (1 g/day) (AAA) for 2 weeks every 2 months for 2 years. RESULTS: Over a 17-year period from August 1, 2002, to July 31, 2019, 63 men and 66 women (median age, 46 years [range, 18-82 years]) received AAA maintenance, which was already completed in 117 patients. At a median follow-up of 100 months (range, 8-215 months), 17 patients (13%) developed first relapse (R1) (hematologic, n = 14; molecular, n = 3) after a median of 19 months (range, 7-96 months) from CR1. Two R1 patients had concomitant central nervous system (CNS) involvement. All patients achieved CR2 with oral As2 O3 -based salvage. Five patients had a subsequent relapse and died. Eight patients died of unrelated causes while still in CR1. The 5-year and 10-year rates of relapse-free survival (RFS) were 89% and 85%, respectively. The 5-year and 10-year rates of overall survival (OS) were 94% and 87%, respectively. Multivariate analysis showed that inferior RFS was associated with FLT3-ITD (P = .005) and CNS involvement on presentation (P = .004), and inferior OS was associated with therapy-related APL (P = .03), FLT3-ITD (P = .03), and relapse (P = .03). The safety profile was favorable, with no grade 3/4 organ toxicities. CONCLUSION: CR1 maintenance with AAA is safe and results in favorable long-term survival in patients with APL. SN - 1097-0142 UR - https://www.unboundmedicine.com/medline/citation/32365228/Oral_arsenic_trioxide,_all-trans_retinoic_acid,_and_ascorbic_acid_maintenance_after_first_complete_remission_in_acute_promyelocytic_leukemia:_Long-term_results_and_unique_prognostic_indicators L2 - https://doi.org/10.1002/cncr.32937 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.