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- Publisher Website: 10.1002/cncr.31327
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- PMID: 29579321
- WOS: WOS:000433568600009
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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
Title | Long-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: A 15-year prospective study |
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Authors | |
Keywords | acute promyelocytic leukemia oral arsenic trioxide maintenance relapse second complete remission |
Issue Date | 2018 |
Publisher | John 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? |
Abstract | BACKGROUND: 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 Identifier | http://hdl.handle.net/10722/252064 |
ISSN | 2023 Impact Factor: 6.1 2023 SCImago Journal Rankings: 2.887 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Singh, GHH | - |
dc.contributor.author | Yim, RLH | - |
dc.contributor.author | Lee, HKK | - |
dc.contributor.author | Mak, V | - |
dc.contributor.author | Lin, SY | - |
dc.contributor.author | Kho, B | - |
dc.contributor.author | Yip, SF | - |
dc.contributor.author | Lau, JSM | - |
dc.contributor.author | Li, W | - |
dc.contributor.author | Ip, HW | - |
dc.contributor.author | Hwang, YYG | - |
dc.contributor.author | Chan, SYT | - |
dc.contributor.author | Tse, EWC | - |
dc.contributor.author | Au, WY | - |
dc.contributor.author | Kumana, CR | - |
dc.contributor.author | Kwong, YL | - |
dc.date.accessioned | 2018-04-10T02:59:34Z | - |
dc.date.available | 2018-04-10T02:59:34Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | Cancer, 2018, v. 124 n. 11, p. 2316-2326 | - |
dc.identifier.issn | 0008-543X | - |
dc.identifier.uri | http://hdl.handle.net/10722/252064 | - |
dc.description.abstract | BACKGROUND: 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.language | eng | - |
dc.publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/28741 | - |
dc.relation.ispartof | Cancer | - |
dc.rights | Cancer. Copyright © John Wiley & Sons, Inc. | - |
dc.subject | acute promyelocytic leukemia | - |
dc.subject | oral arsenic trioxide maintenance | - |
dc.subject | relapse | - |
dc.subject | second complete remission | - |
dc.title | Long-term outcome of relapsed acute promyelocytic leukemia treated with oral arsenic trioxide-based reinduction and maintenance regimens: A 15-year prospective study | - |
dc.type | Article | - |
dc.identifier.email | Singh, GHH: gillhsh@hku.hk | - |
dc.identifier.email | Yim, RLH: ritayim@hku.hk | - |
dc.identifier.email | Ip, HW: iphowan@hku.hk | - |
dc.identifier.email | Hwang, YYG: yyhwang@hku.hk | - |
dc.identifier.email | Chan, SYT: drtchan@hku.hk | - |
dc.identifier.email | Tse, EWC: ewctse@hku.hk | - |
dc.identifier.email | Kumana, CR: hrmekcr@hku.hk | - |
dc.identifier.email | Kwong, YL: ylkwong@hkucc.hku.hk | - |
dc.identifier.authority | Singh, GHH=rp01914 | - |
dc.identifier.authority | Tse, EWC=rp00471 | - |
dc.identifier.authority | Kwong, YL=rp00358 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1002/cncr.31327 | - |
dc.identifier.pmid | 29579321 | - |
dc.identifier.scopus | eid_2-s2.0-85044430378 | - |
dc.identifier.hkuros | 284751 | - |
dc.identifier.volume | 124 | - |
dc.identifier.issue | 11 | - |
dc.identifier.spage | 2316 | - |
dc.identifier.epage | 2326 | - |
dc.identifier.isi | WOS:000433568600009 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 0008-543X | - |