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Conference Paper: Oral arsenic trioxide - based maintenance without hematopoietic stem cell transplantation at second remission in acute promyelocytic leukemia - a prospective follow-up study of 65 patients

TitleOral arsenic trioxide - based maintenance without hematopoietic stem cell transplantation at second remission in acute promyelocytic leukemia - a prospective follow-up study of 65 patients
Authors
Issue Date2013
PublisherAmerican Society of Hematology. The Journal's web site is located at http://bloodjournal.hematologylibrary.org/
Citation
The 55th Annual Meeting and Exposition of the American Society of Hematology (ASH 2013), New Orleans, LA., 7-10 December 2013. In Blood, 2013, v. 122 n. 21 How to Cite?
AbstractApproximately 20 percent of patients with acute promyelocytic leukemia (APL) relapse after initial remission. More than 80 percent of these patients achieve a second complete remission (CR2). Autologous hematopoietic stem cell transplantation (HSCT) at CR2 is a widely accepted post-remission strategy. However, only a few prospective trials have examined the optimal post-remission therapy for relapsed APL. In this study, we prospectively evaluated the outcome of 65 patients with APL in their first relapse (R1) treated with oral arsenic trioxide (As2O3) and chemotherapy-based re-induction followed by oral arsenic trioxide-based maintenance. Sixty-five patients (men=37; women=28) at a median age of 39 (3-76) years were treated with oral As2O3, all-trans retinoic acid (ATRA), and ascorbic acid combined with idarubicin (6mg/m2/day for 5 days) for re-induction. On achieving CR2, 2 cycles of idarubicin consolidation (6mg/m2/day for 2 days each cycle) were given. That was followed by oral As2O3-based maintenance (2 weeks every 2 months) for 2 years. The median duration of follow-up was 90 (21–378) months. All evaluable patients achieved CR2. Twenty-one patients (32.8%) subsequently had a second relapse (R2). On multivariate analysis, male gender was associated with an increased risk of second relapse (P=0.01). The age, white blood cell (WBC) count, platelet count, peak WBC during reinduction and the occurrence of differentiation syndrome did not impact on the risk of second relapse. The median overall survival (OS) was not reached. The 5-year and 10-year OS were 82.2% and 74.4% respectively. Significantly inferior OS was associated with male gender (P=0.02), prior oral As2O3-based maintenance at CR1 (P=0.01) and central nervous system (CNS) involvement at relapse (P<0.001). The median leukemia-free survival (LFS) after CR2 was not reached. The 2-year and 5-year LFS were 72.4% and 64.1% respectively. Male gender and relapse from prior oral As2O3-based maintenance at CR1 were associated with worse LFS (P=0.01 and P=0.04 respectively). In conclusion, our study showed that durable remissions and long-term survival were achieved with oral As2O3-based maintenance without the need of autologous HSCT at CR2. © 2013 by The American Society of Hematology
DescriptionThis journal issue contain 2013 ASH Annual Meeting Abstracts
Persistent Identifierhttp://hdl.handle.net/10722/207343
ISSN
2015 Impact Factor: 11.841
2015 SCImago Journal Rankings: 6.395

 

DC FieldValueLanguage
dc.contributor.authorGill, Hen_US
dc.contributor.authorAu, WYen_US
dc.contributor.authorKwong, YLen_US
dc.date.accessioned2014-12-19T10:54:27Z-
dc.date.available2014-12-19T10:54:27Z-
dc.date.issued2013en_US
dc.identifier.citationThe 55th Annual Meeting and Exposition of the American Society of Hematology (ASH 2013), New Orleans, LA., 7-10 December 2013. In Blood, 2013, v. 122 n. 21en_US
dc.identifier.issn0006-4971-
dc.identifier.urihttp://hdl.handle.net/10722/207343-
dc.descriptionThis journal issue contain 2013 ASH Annual Meeting Abstracts-
dc.description.abstractApproximately 20 percent of patients with acute promyelocytic leukemia (APL) relapse after initial remission. More than 80 percent of these patients achieve a second complete remission (CR2). Autologous hematopoietic stem cell transplantation (HSCT) at CR2 is a widely accepted post-remission strategy. However, only a few prospective trials have examined the optimal post-remission therapy for relapsed APL. In this study, we prospectively evaluated the outcome of 65 patients with APL in their first relapse (R1) treated with oral arsenic trioxide (As2O3) and chemotherapy-based re-induction followed by oral arsenic trioxide-based maintenance. Sixty-five patients (men=37; women=28) at a median age of 39 (3-76) years were treated with oral As2O3, all-trans retinoic acid (ATRA), and ascorbic acid combined with idarubicin (6mg/m2/day for 5 days) for re-induction. On achieving CR2, 2 cycles of idarubicin consolidation (6mg/m2/day for 2 days each cycle) were given. That was followed by oral As2O3-based maintenance (2 weeks every 2 months) for 2 years. The median duration of follow-up was 90 (21–378) months. All evaluable patients achieved CR2. Twenty-one patients (32.8%) subsequently had a second relapse (R2). On multivariate analysis, male gender was associated with an increased risk of second relapse (P=0.01). The age, white blood cell (WBC) count, platelet count, peak WBC during reinduction and the occurrence of differentiation syndrome did not impact on the risk of second relapse. The median overall survival (OS) was not reached. The 5-year and 10-year OS were 82.2% and 74.4% respectively. Significantly inferior OS was associated with male gender (P=0.02), prior oral As2O3-based maintenance at CR1 (P=0.01) and central nervous system (CNS) involvement at relapse (P<0.001). The median leukemia-free survival (LFS) after CR2 was not reached. The 2-year and 5-year LFS were 72.4% and 64.1% respectively. Male gender and relapse from prior oral As2O3-based maintenance at CR1 were associated with worse LFS (P=0.01 and P=0.04 respectively). In conclusion, our study showed that durable remissions and long-term survival were achieved with oral As2O3-based maintenance without the need of autologous HSCT at CR2. © 2013 by The American Society of Hematology-
dc.languageengen_US
dc.publisherAmerican Society of Hematology. The Journal's web site is located at http://bloodjournal.hematologylibrary.org/en_US
dc.relation.ispartofBlooden_US
dc.rightsThis research was originally published in The Hematologist: ASH News and Reports. Author(s). Title. The Hematologist: ASH News and Reports. Year;Vol,Issue:pp-pp. © the American Society of Hematology.-
dc.titleOral arsenic trioxide - based maintenance without hematopoietic stem cell transplantation at second remission in acute promyelocytic leukemia - a prospective follow-up study of 65 patientsen_US
dc.typeConference_Paperen_US
dc.identifier.emailKwong, YL: ylkwong@hku.hken_US
dc.identifier.authorityKwong, YL=rp00358en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.hkuros241797en_US
dc.identifier.volume122en_US
dc.identifier.issue21en_US
dc.publisher.placeUnited States-

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