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

Abstract

Acute promyelocytic leukemia has good prognosis in view of the high complete remission and survival rates achieved with therapies containing all-trans retinoic acid or arsenic trioxide. However, there is a significant risk of death during induction due to hemorrhage secondary to disseminated intravascular coagulation. This has contributed to a gap in the prognosis of patients between developed and developing countries. The International Consortium on Acute Promyelocytic Leukemia was created in 2005 and proposed a treatment protocol based on daunorubicin and all-trans retinoic acid stratified by risk geared toward developing countries. Herein are presented the results from the first patient cohort treated in a single developing country hospital employing a slightly modified version of the International Consortium protocol in a real life setting. Twenty patients with acute promyelocytic leukemia were enrolled: 27.8% had low-risk, 55.6% intermediate risk and 16.7% high-risk. The complete remission rate was 94.4% after a median of 42 days. Both relapse rates and death rates were one patient (5.5%) each. No deaths were observed during consolidation. After a median follow-up of 29 months, the overall survival rate was 89.1%. Efficacy and safety of the International Consortium on Acute Promyelocytic Leukemia protocol has been reproduced in acute promyelocytic leukemia patients from a developing country.

microRNAs and Acute Myeloid Leukemia Chemoresistance: A Mechanistic Overview

“…Notwithstanding, drug resistance is a major therapeutic challenge in the treatment of AML. Failure of initial therapy can be observed in up to 40% of AML patients, and even when initial therapy is effective, up to 70% of patients eventually succumb to their disease due to aggressive relapse within 5 years ( 5 – 7 ).…”

Cost-effectiveness of the regimen proposed by the International Consortium on Acute Promyelocytic Leukemia for the treatment of newly diagnosed patients with Acute Promyelocytic Leukemia

“…The modified IC-APL protocol is specified in the Crespo-Solis study and is composed of three phases: (1) an induction phase (ATRA plus DNR); (2) a consolidation phase (ATRA plus DNR, Ara-C and MTZ), and (3) a maintenance phase (ATRA plus MTX and 6-MP) ( Table 1 ), diverting from the IC-APL in the administration of prophylactic intrathecal chemotherapy to patients considered to be at high risk. 15 , 16 …”

“… 17 Risk stratification followed the recommendations of Sanz et al , considering patients at low risk those with a white blood cell (WBC) count <10 × 10 9 /L and a platelet count >40 × 10 9 /L, at intermediate risk those with a WBC < 10 × 10 9 /L and a platelet count <40 × 10 9 /L and at high risk those with a WBC ≥ 10 × 10 9 /L. 16 , 18 Concerning survival parameters, definition of CR rates, disease-free survival (DFS) and OS were considered the same as those in Crespo-Solís et al 15 For the ATRA plus ATO and ATRA plus idarubicin (IDA) protocols, we considered the data available from Lo-Coco et al 7 and for the ATRA plus Ara-C or DNR protocol, we considered the data from Ades et al and Powell et al 19 , 20 …”

Essential gene networks in acute myeloid leukemia identified using a microRNA-knockout CRISPR library screen

“…Notwithstanding, drug resistance is also a major therapeutic challenge in the treatment of AML. Failure of initial therapy can be observed in up to 40% of AML patients, and even when initial therapy is effective, up to 70% of patients eventually succumb to their disease due to aggressive relapse within 5 years [29][30][31]. Therapies that modulate the growth of AML by targeting essential pathways may prove to be beneficial.…”