Treatment of newly diagnosed patients with acute promyelocytic leukemia with modified spanish treatment protocol

Abstract

The results of treatment of acute promyelocytic leukemia, when combination ATRA + chemotherapy is used in induction and maintainance therapy and risk adapted strategy applied in consolidation, improved at present time. Enhanced supportive therapy also contribute to improved outcome of APL patients. 3 -year relapse free, overall survival and clinical and biological presenting features of APL patients were evaluated. Since january 2001 till march 2009 32 patients treated with modified spanish treatment scheme were assesed. After june 2003 risk adapted strategy in protocol therapy according to spanish treatment group with ATRA and anthracyclines in consolidation therapy in high and intermediate risk patients was used. Cytoreduction therapy in patients with initially high leukocyte count was the modification of spanish treatment scheme. 29 (90,6 %) patients achieved complete hematologic remission, 2 (6,3 %) molecular relapses were observed, death was observed in 4 patients (12,5 %). The estimated 3-year OS was 90,6 %; 95 % CI (80,5 % -100,0 %), and estimated 3-year RFS was 95,5 %; 95 % CI (86,8 % -100,0 %). Survival results correspond with other published clinical studies. The number of relapses was slightly lower and the incidence of ATRA syndrome (50 %) was higher when compare with the results of other study groups. Current recommendations for treatment with risk-adapted strategy for patients with newly diagnosed acute promyelocytic leukemia resulted in our patients group to comparable outcome and good compliance like in other published studies.Key words: leukemia, APL, ATRA, therapy, protocol, survival Acute promyelocytic leukemia (APL) is an infrequent type of leukemia with incidence rate of 0,7 per milion persons per year and form about 5 % -10 % of adult acute myeloblastic leukemias (AML) [1]. Current treatment strategy has significantly improved prognosis of this type of leukemia. In induction treatment of APL the combination of ATRA (all-trans retinoic acid) with anthracycline is recomended. The use of ATO based regimens should be restricted to patients in whom chemotherapy is contraindicated or for those included in clinical trials. In consolidation at least two cycles of anthracycline ± ATRA are recomended, whereby the doses of anthracycline and the addition of ATRA depends on the stratification of the patient according to risk group (Sanz et al.) [2]. In the maintenance treatment two years of ATRA with low dose chemotherapy is recomended, whereby the discussion about necessity and benefits of maintenance therapy in low risk patients and those, who achieved complete molecular remission at the end of consolidation therapy, is in progress [3]. Spanish treatment group PETHEMA achieved excellent results in the studies LPA96 and LPA99 in the treatment of APL with minimal toxicity [2,4]. We decided to analyze and compare achieved results of the treatment in our group of patients with the results of published clinical studies. The aim of present analysis was evaluation of 3 -year relapse free survival (RFS) an...