Induction treatments for acute promyelocytic leukemia: a network meta-analysis

Abstract

Background9 treatments for acute promyelocytic leukemia (APL) have been compared in many randomized controlled trials (RCT). The conclusions have been inconsistent and the purpose of this study is to conduct a network meta-analysis.ResultsRankings of event-free survival are ATRA+RIF (81.2%), ATRA+ATO (69.6%), ATO (50.6%). Rankings of complete remission are ATRA+RIF (79.3%), ATRA+ATO (64.8%), RIF (60.3%), ATO (55.9%). Rankings of avoiding differentiation syndromes are CT (84.3%), ATO (80.3%), RIF (71.6%), ATRA+RIF (49%), ATRA+ATO (40.8%).MethodsA total of 1,666 patients from 12 RCTs were enrolled. The frequentist method was used. Relative risks with 95% confidence intervals were calculated. We produced a network plot, a contribution plot, and a forest plot predictive intervals. The inconsistency factor, the surface under the cumulative ranking curve and the publication bias were evaluated.ConclusionsATRA+ATO is eligible to be the first-line treatment for APL. ATRA+RIF is a prospective alternative to the first-line treatment. RIF or ATO should be reconsidered as another option for de novo APL.

The Survival of Patients with t(15;17)(q22;q12) Positive Acute Promyelocytic Leukemia: A Study in North-East of Iran

“…Rarely, RARA may be fused with genes other than PML. The alternative variant partners of RARA include PLZF (ZBTB16), NPM1 and STAT5b (7,8 While ATO generally promotes favorable responses only in cases with PML-RARA fusion, ATRA is also effective in cases with NPM1, NUMA and FIP1L1 fusion partners (9)(10)(11). Survival studies in patients with hematologic malignancies provide valuable insights into the identification of parameters associated with high mortalities and also provide us with opportunities to improve life expectancy of at-risk patients.…”

“…ATRA and arsenic trioxide (ATO) are current medications for t(15;17)(q22;q12) positive AML. While ATO generally promotes favorable responses only in cases with PML-RARA fusion, ATRA is also effective in cases with NPM1, NUMA and FIP1L1 fusion partners ( 9 - 11 ).…”

Acute Promyelocytic Leukemia: A Summary

“…An early study demonstrated that those patients who were untreated or treated with corticosteroids only had a median survival of less than 1 week (Cooperberg & Neiman, 1955). Cytotoxic chemotherapy was initially used, and helped patients achieve a CR, yet provided a low survival rate due to complications and relapses (Huang et al, 2016). The breakthrough in the treatment of APL came with the introduction of ATRA, which increased the remission rate, but approximately 30% of patients would still relapse (Huang et al, 2016).…”

“…Cytotoxic chemotherapy was initially used, and helped patients achieve a CR, yet provided a low survival rate due to complications and relapses (Huang et al, 2016). The breakthrough in the treatment of APL came with the introduction of ATRA, which increased the remission rate, but approximately 30% of patients would still relapse (Huang et al, 2016). Subsequent trials investigated the combination of ATRA and chemotherapy, which raised the eventfree survival rate.…”

Hop-derived Xanthohumol Induces HL-60 Leukemia Cells Death

“…Each year about 600-800 new cases of leukemia are diagnosed in the USA [1]. Although APL has a good prognosis however if the diseases is untreated or relapses, the mortality rate is high and approximately 30% of patients relapse [2][3]. Epidemiologic studies show that APL is more common in children and young adult patients and among Hispanics [4].…”