Treating acute promyelocytic leukaemia in Latin America: lessons from the International Consortium on Acute Leukaemia experience

Koury, Luisa Corrêa de Araujo; Ganser, Arnold; Berliner, Nancy; Rego, Eduardo Magalhães

doi:10.1111/bjh.14589

Cited by 12 publications

(6 citation statements)

References 17 publications

(26 reference statements)

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“…Several expert panels have recommended that molecular remission should be considered a therapeutic objective in APL, and molecular response has been adopted as a study endpoint in modern clinical trials [ 273 ]. APL patients around the world should soon undergo this curative treatment, perhaps based on oral formulations [ 274 ]. Oral administration raises the possibility of implementing treatment as outpatient care, thus increasing quality of life and decreasing medical costs [ 269 , 275 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Promyelocytic Leukemia: A History over 60 Years—From the Most Malignant to the most Curable Form of Acute Leukemia

Thomas

2019

Oncol Ther

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Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) that is cytogenetically characterized by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion of the promyelocytic leukemia (PML) and retinoic acid receptor alpha (RARa) genes. Because patients with APL present a tendency for severe bleeding, often resulting in an early fatal course, APL was historically considered to be one of the most fatal forms of acute leukemia. However, therapeutic advances, including anthracyclineand cytarabine-based chemotherapy, have significantly improved the outcomes of APL patients. Due to the further introduction of alltrans retinoic acid (ATRA) and-more recentlythe development of arsenic trioxide (ATO)containing regimens, APL is currently the most curable form of AML in adults. Treatment with these new agents has introduced the concept of cure through targeted therapy. With the advent of revolutionary ATRA-ATO combination therapies, chemotherapy can now be safely omitted from the treatment of low-risk APL patients. In this article, we review the six-decade history of APL, from its initial characterization to the era of chemotherapy-free ATRA-ATO, a model of cancer-targeted therapy.

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Section: Discussionmentioning

confidence: 99%

Acute Promyelocytic Leukemia: A History over 60 Years—From the Most Malignant to the most Curable Form of Acute Leukemia

Thomas

2019

Oncol Ther

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“…Treatments costs are expected to decline sharply, allowing their broader use. In every country in the world, APL patients should soon be able to undergo simple, definitively curative treatments and may even shift to oral formulations (Correa de Araujo Koury et al, 2017). The most dreaded type of all leukemia has shifted from a fear of the past into a paradigm for the future success of targeted therapies.…”

Section: Introductionmentioning

confidence: 99%

Acute Promyelocytic Leukemia: A Paradigm for Oncoprotein-Targeted Cure

2017

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Recent clinical trials have demonstrated that the immense majority of acute promyelocytic leukemia (APL) patients can be definitively cured by the combination of two targeted therapies: retinoic acid (RA) and arsenic. Mouse models have provided unexpected insights into the mechanisms involved. Restoration of PML nuclear bodies upon RA- and/or arsenic-initiated PML/RARA degradation is essential, while RA-triggered transcriptional activation is dispensable for APL eradication. Mutations of the arsenic-binding site of PML/RARA, but also PML, have been detected in therapy-resistant patients, demonstrating the key role of PML in APL cure. PML nuclear bodies are druggable and could be harnessed in other conditions.

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“…Some of the lessons learned by this initiative were that establishing clinical networks involving developed and DC may be a very useful strategy. It favors simpler diagnosis methods, the implementation of national reference laboratories allowing training of laboratory personnel in new technologies, and quality control routines as well as foster medical education by training clinical staff and creating exchange of experiences and guidelines [63]. This kind of collaboration could be extrapolated to other scenarios, for instance, reduce the higher morbidity and mortality rates from infection in AML through the implementation of better diagnostic methods that allowed more properly designed studies evaluating the bacterial and fungal epidemiology of each country.…”

Section: Possible Solutionsmentioning

confidence: 99%

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

Meillón-Garcı́a

Demichelis‐Gómez

2020

Curr Oncol Rep

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Purpose of Review Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. Recent Findings DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. Summary The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.

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Treating acute promyelocytic leukaemia in Latin America: lessons from the International Consortium on Acute Leukaemia experience

Cited by 12 publications

References 17 publications

Acute Promyelocytic Leukemia: A History over 60 Years—From the Most Malignant to the most Curable Form of Acute Leukemia

Acute Promyelocytic Leukemia: A History over 60 Years—From the Most Malignant to the most Curable Form of Acute Leukemia

Acute Promyelocytic Leukemia: A Paradigm for Oncoprotein-Targeted Cure

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

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