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Article: Oral arsenic trioxide, all‐trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long‐term results and unique prognostic indicators
Title | Oral arsenic trioxide, all‐trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long‐term results and unique prognostic indicators |
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Authors | |
Keywords | acute promyelocytic leukemia arsenic trioxide first completion remission maintenance oral |
Issue Date | 2020 |
Publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0142 |
Citation | Cancer, 2020, v. 126 n. 14, p. 3244-3254 How to Cite? |
Abstract | Background:
The role of arsenic trioxide (As2O3) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear.
Methods:
A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all‐trans retinoic acid [ATRA]/daunorubicin) and consolidation (daunorubicin/cytarabine [induction daunorubicin and consolidation omitted for age ≥70 years]) underwent maintenance comprising ATRA (45 mg/m2/day), oral As2O3 (10 mg/day), and ascorbic acid (1 g/day) (AAA) for 2 weeks every 2 months for 2 years.
Results:
Over a 17‐year period from August 1, 2002, to July 31, 2019, 63 men and 66 women (median age, 46 years [range, 18‐82 years]) received AAA maintenance, which was already completed in 117 patients. At a median follow‐up of 100 months (range, 8‐215 months), 17 patients (13%) developed first relapse (R1) (hematologic, n = 14; molecular, n = 3) after a median of 19 months (range, 7‐96 months) from CR1. Two R1 patients had concomitant central nervous system (CNS) involvement. All patients achieved CR2 with oral As2O3‐based salvage. Five patients had a subsequent relapse and died. Eight patients died of unrelated causes while still in CR1. The 5‐year and 10‐year rates of relapse‐free survival (RFS) were 89% and 85%, respectively. The 5‐year and 10‐year rates of overall survival (OS) were 94% and 87%, respectively. Multivariate analysis showed that inferior RFS was associated with FLT3‐ITD (P = .005) and CNS involvement on presentation (P = .004), and inferior OS was associated with therapy‐related APL (P = .03), FLT3‐ITD (P = .03), and relapse (P = .03). The safety profile was favorable, with no grade 3/4 organ toxicities.
Conclusion:
CR1 maintenance with AAA is safe and results in favorable long‐term survival in patients with APL. |
Persistent Identifier | http://hdl.handle.net/10722/282528 |
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, HSG | - |
dc.contributor.author | Yim, RY | - |
dc.contributor.author | Kumana, CR | - |
dc.contributor.author | Tse, E | - |
dc.contributor.author | Kwong, Y-L | - |
dc.date.accessioned | 2020-05-15T05:29:17Z | - |
dc.date.available | 2020-05-15T05:29:17Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | Cancer, 2020, v. 126 n. 14, p. 3244-3254 | - |
dc.identifier.issn | 0008-543X | - |
dc.identifier.uri | http://hdl.handle.net/10722/282528 | - |
dc.description.abstract | Background: The role of arsenic trioxide (As2O3) in the maintenance of first complete remission (CR1) in acute promyelocytic leukemia (APL) is unclear. Methods: A total of 129 consecutive adult patients with APL of all risk categories who achieved CR1 with conventional induction (all‐trans retinoic acid [ATRA]/daunorubicin) and consolidation (daunorubicin/cytarabine [induction daunorubicin and consolidation omitted for age ≥70 years]) underwent maintenance comprising ATRA (45 mg/m2/day), oral As2O3 (10 mg/day), and ascorbic acid (1 g/day) (AAA) for 2 weeks every 2 months for 2 years. Results: Over a 17‐year period from August 1, 2002, to July 31, 2019, 63 men and 66 women (median age, 46 years [range, 18‐82 years]) received AAA maintenance, which was already completed in 117 patients. At a median follow‐up of 100 months (range, 8‐215 months), 17 patients (13%) developed first relapse (R1) (hematologic, n = 14; molecular, n = 3) after a median of 19 months (range, 7‐96 months) from CR1. Two R1 patients had concomitant central nervous system (CNS) involvement. All patients achieved CR2 with oral As2O3‐based salvage. Five patients had a subsequent relapse and died. Eight patients died of unrelated causes while still in CR1. The 5‐year and 10‐year rates of relapse‐free survival (RFS) were 89% and 85%, respectively. The 5‐year and 10‐year rates of overall survival (OS) were 94% and 87%, respectively. Multivariate analysis showed that inferior RFS was associated with FLT3‐ITD (P = .005) and CNS involvement on presentation (P = .004), and inferior OS was associated with therapy‐related APL (P = .03), FLT3‐ITD (P = .03), and relapse (P = .03). The safety profile was favorable, with no grade 3/4 organ toxicities. Conclusion: CR1 maintenance with AAA is safe and results in favorable long‐term survival in patients with APL. | - |
dc.language | eng | - |
dc.publisher | John Wiley & Sons, Inc. The Journal's web site is located at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0142 | - |
dc.relation.ispartof | Cancer | - |
dc.rights | Preprint This is the pre-peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Postprint This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. | - |
dc.subject | acute promyelocytic leukemia | - |
dc.subject | arsenic trioxide | - |
dc.subject | first completion remission | - |
dc.subject | maintenance | - |
dc.subject | oral | - |
dc.title | Oral arsenic trioxide, all‐trans retinoic acid, and ascorbic acid maintenance after first complete remission in acute promyelocytic leukemia: Long‐term results and unique prognostic indicators | - |
dc.type | Article | - |
dc.identifier.email | Singh, HSG: gillhsh@hku.hk | - |
dc.identifier.email | Yim, RY: ritayim@hku.hk | - |
dc.identifier.email | Tse, E: ewctse@hku.hk | - |
dc.identifier.email | Kwong, Y-L: ylkwong@hkucc.hku.hk | - |
dc.identifier.authority | Singh, HSG=rp01914 | - |
dc.identifier.authority | Tse, E=rp00471 | - |
dc.identifier.authority | Kwong, Y-L=rp00358 | - |
dc.description.nature | link_to_OA_fulltext | - |
dc.identifier.doi | 10.1002/cncr.32937 | - |
dc.identifier.scopus | eid_2-s2.0-85085075442 | - |
dc.identifier.hkuros | 309886 | - |
dc.identifier.volume | 126 | - |
dc.identifier.issue | 14 | - |
dc.identifier.spage | 3244 | - |
dc.identifier.epage | 3254 | - |
dc.identifier.isi | WOS:000530436100001 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 0008-543X | - |