Acute promyelocytic leukemia in patients aged >70 years: the cure beyond the age

Abstract

All-trans retinoic acid (ATRA) has made acute promyelocytic leukemia (APL) a very curable disease also in patients aged >60 years; however, there are only few case reports in very elderly APL patients. To address this issue, we reviewed treatment results in 13 patients aged >70 years with newly diagnosed APL followed at our institution from January 1991 to December 2008. According to Sanz score, seven patients were at low risk, five at intermediate risk, and one at high risk. Induction therapy consisted of ATRA + idarubicin in nine patients (3/9 with reduced idarubicin dosage) and ATRA alone in four patients; in this latter group, however, 2/4 needed to add chemotherapy (CHT) due to hyperleukocytosis during ATRA treatment. All patients achieved both morphological and molecular complete remission (CR) after a median time of 51 [interquartile range (IR) 43-55] and 114 (IR 74-155) days, respectively. Infective complications were observed in 10/13 patients, APL differentiation syndrome in 3/13 patients. Twelve patients received consolidation therapy, followed by maintenance treatment in nine patients. Five patients relapsed after 7, 8, 11, 35, and 56 months. At present, seven patients are still alive, five died due to disease progression (four) or senectus while in CR (one), and one was lost to follow-up while in CR. The 5-year event-free survival was 56.1 % (95 % CI, 26.0-86.2); the 5-year overall survival (OS) was 64.5 % (95 % CI, 35.6-93.4). ATRA-based treatment of APL is safe and effective also in very elderly patients, with long-lasting disease-free OS.

Survival and treatment response in adults with acute promyelocytic leukemia treated with a modified International Consortium on Acute Promyelocytic Leukemia protocol

“…Although the number of over 65-year-old patients in this cohort is small, they all are nevertheless alive and in CR which coincides with the data reported by other groups that have described long OS in the elderly 27 . It is important to mention that the over 65-year olds in this study had severe neutropenia and infectious complications during induction.…”

Acute myeloid leukemia in the elderly (age 70 yr or older): long‐term survivors

“…Subsequent courses of low‐intensity treatment were administered after intervals of 4–6 wk until disease progression. Four patients receiving tipifarnib , one patient with del5q− who received lenalidomide , and one patient with APL who only received ATRA were also included in this study group. Policies with regard to blood product support, antibiotics and antifungal prophylaxis, and treatment of febrile neutropenia were determined by established local practice .…”

6-Formylindolo(3,2-b)Carbazole (FICZ) Modulates the Signalsome Responsible for RA-Induced Differentiation of HL-60 Myeloblastic Leukemia Cells

“…Some experts therefore advocate a front line therapy of RA and arsenic trioxide without chemotherapy from the initial diagnosis for patients with low to intermediate risk APL [ 9 – 11 ]. In elderly APL patients, or patients not qualifying for chemotherapy or arsenic trioxide therapy due to concurrent disease, RA as a single therapy was reported to be effective in both induction and maintenance of remission [ 12 , 13 ]. Clinically achievable plasma concentrations reach 1 μM, which is the concentration typically used in in vitro studies [ 14 ].…”