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Article: Long-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: A 15-year prospective study

TitleLong-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: A 15-year prospective study
Authors
Keywordsacute promyelocytic leukemia
oral arsenic trioxide maintenance
relapse
second complete remission
Issue Date2018
PublisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/28741
Citation
Cancer, 2018, v. 124 n. 11, p. 2316-2326 How to Cite?
AbstractBACKGROUND: For patients who have acute promyelocytic leukemia (APL) in second complete remission (CR2), optimal postremission strategies remain undefined. METHODS: The role of an oral arsenic trioxide (As2O3)-based regimen in the management of patients who had APL in CR2 was examined. RESULTS: Seventy-three patients with APL in first relapse (R1) were studied. Oral As2O3-based reinduction resulted uniformly in CR2, irrespective of previous As2O3 exposure. All patients received oral As2O3-based maintenance in CR2. At a median follow-up of 94 months (range, 9-205 months), 43 patients (58.9%) were still in CR2, and 49 (67.1%) had finished the planned 2-year CR2 maintenance with all-trans retinoic acid, oral As2O3, and ascorbic acid. Reinduction and maintenance treatments were well tolerated. Grade 1 and 2 headache occurred in 20 patients (27.4%). Hepatotoxicity, all in the form of transaminitis, occurred in 35 patients (47.9%; grade 1 and 2, n = 26; grade 3 and 4, n = 9). Three patients had self-limiting QTc prolongation. The 10-year leukemia-free survival rate was 56.8%. Thirty patients developed R2. Oral As2O3-based reinduction led to CR3 in 27 patients (90%). Post-CR3 strategies included autologous hematopoietic stem cell transplantation and oral As2O3 maintenance. At a post-CR3 follow-up of 30 months (range, 3-166 months), 11 patients were still in CR3. The 5-year and 10-year overall survival rates in the R1 cohort were 79.5% and 67.3%, respectively. Prior receipt of oral As2O3 maintenance in CR1 was the only risk factor for inferior leukemia-free survival. Central nervous system involvement occurred in 15 patients, including 5 who remained alive. Relapse during oral As2O3 therapy was the only significant risk factor for central nervous system involvement. CONCLUSIONS: For patients with relapsed APL, As2O3 remained effective despite repeated As2O3 exposures. Oral As2O3 maintenance was an effective postremission strategy for CR2. Cancer 2018;124:2316-26. © 2018 American Cancer Society. © 2018 American Cancer Society
Persistent Identifierhttp://hdl.handle.net/10722/252064
ISSN
2017 Impact Factor: 6.537
2015 SCImago Journal Rankings: 3.188
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSingh, GHH-
dc.contributor.authorYim, RLH-
dc.contributor.authorLee, HKK-
dc.contributor.authorMak, V-
dc.contributor.authorLin, SY-
dc.contributor.authorKho, B-
dc.contributor.authorYip, SF-
dc.contributor.authorLau, JSM-
dc.contributor.authorLi, W-
dc.contributor.authorIp, HW-
dc.contributor.authorHwang, YYG-
dc.contributor.authorChan, SYT-
dc.contributor.authorTse, EWC-
dc.contributor.authorAu, WY-
dc.contributor.authorKumana, CR-
dc.contributor.authorKwong, YL-
dc.date.accessioned2018-04-10T02:59:34Z-
dc.date.available2018-04-10T02:59:34Z-
dc.date.issued2018-
dc.identifier.citationCancer, 2018, v. 124 n. 11, p. 2316-2326-
dc.identifier.issn0008-543X-
dc.identifier.urihttp://hdl.handle.net/10722/252064-
dc.description.abstractBACKGROUND: For patients who have acute promyelocytic leukemia (APL) in second complete remission (CR2), optimal postremission strategies remain undefined. METHODS: The role of an oral arsenic trioxide (As2O3)-based regimen in the management of patients who had APL in CR2 was examined. RESULTS: Seventy-three patients with APL in first relapse (R1) were studied. Oral As2O3-based reinduction resulted uniformly in CR2, irrespective of previous As2O3 exposure. All patients received oral As2O3-based maintenance in CR2. At a median follow-up of 94 months (range, 9-205 months), 43 patients (58.9%) were still in CR2, and 49 (67.1%) had finished the planned 2-year CR2 maintenance with all-trans retinoic acid, oral As2O3, and ascorbic acid. Reinduction and maintenance treatments were well tolerated. Grade 1 and 2 headache occurred in 20 patients (27.4%). Hepatotoxicity, all in the form of transaminitis, occurred in 35 patients (47.9%; grade 1 and 2, n = 26; grade 3 and 4, n = 9). Three patients had self-limiting QTc prolongation. The 10-year leukemia-free survival rate was 56.8%. Thirty patients developed R2. Oral As2O3-based reinduction led to CR3 in 27 patients (90%). Post-CR3 strategies included autologous hematopoietic stem cell transplantation and oral As2O3 maintenance. At a post-CR3 follow-up of 30 months (range, 3-166 months), 11 patients were still in CR3. The 5-year and 10-year overall survival rates in the R1 cohort were 79.5% and 67.3%, respectively. Prior receipt of oral As2O3 maintenance in CR1 was the only risk factor for inferior leukemia-free survival. Central nervous system involvement occurred in 15 patients, including 5 who remained alive. Relapse during oral As2O3 therapy was the only significant risk factor for central nervous system involvement. CONCLUSIONS: For patients with relapsed APL, As2O3 remained effective despite repeated As2O3 exposures. Oral As2O3 maintenance was an effective postremission strategy for CR2. Cancer 2018;124:2316-26. © 2018 American Cancer Society. © 2018 American Cancer Society-
dc.languageeng-
dc.publisherJohn Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/28741-
dc.relation.ispartofCancer-
dc.rightsCancer. Copyright © John Wiley & Sons, Inc.-
dc.subjectacute promyelocytic leukemia-
dc.subjectoral arsenic trioxide maintenance-
dc.subjectrelapse-
dc.subjectsecond complete remission-
dc.titleLong-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: A 15-year prospective study-
dc.typeArticle-
dc.identifier.emailSingh, GHH: gillhsh@hku.hk-
dc.identifier.emailYim, RLH: ritayim@hku.hk-
dc.identifier.emailIp, HW: iphowan@hku.hk-
dc.identifier.emailHwang, YYG: yyhwang@hku.hk-
dc.identifier.emailChan, SYT: drtchan@hku.hk-
dc.identifier.emailTse, EWC: ewctse@hku.hk-
dc.identifier.emailKumana, CR: hrmekcr@hku.hk-
dc.identifier.emailKwong, YL: ylkwong@hkucc.hku.hk-
dc.identifier.authoritySingh, GHH=rp01914-
dc.identifier.authorityTse, EWC=rp00471-
dc.identifier.authorityKwong, YL=rp00358-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1002/cncr.31327-
dc.identifier.pmid29579321-
dc.identifier.scopuseid_2-s2.0-85044430378-
dc.identifier.hkuros284751-
dc.identifier.volume124-
dc.identifier.issue11-
dc.identifier.spage2316-
dc.identifier.epage2326-
dc.identifier.isiWOS:000433568600009-
dc.publisher.placeUnited States-

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