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KMID : 0338420220370040841
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The Korean Journal of Internal Medicine
2022 Volume.37 No. 4 p.841 ~ p.850
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Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia
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Park Young-Hoon
Kim Dae-Young
Mun Yeung-Chul
Cho Eun-Kyung
Lee Jae-Hoon
Jo Deog-Yeon
Kim In-Ho
Yoon Sung-Soo
Park Seon-Yang
Kim Byoung-Kook
Bang Soo-Mee
Kim Hawk
Min Young-Joo
Park Jae-Hoo
Seo Jong-JIn
Moon Hyung-Nam
Lee Moon-Hee
Kim Chul-Soo
Lee Won-Sik
Chong So-Young
Oh Do-Yeun
Zang Dae-Young
Lee Kyung-Hee
Hyun Myung-Soo
Kim Heung-Sik
Kim Sung-Hyun
Kwon Hyuk-Chan
Kim Hyo-Jin
Park Kyung-Tae
Bae Sung-Hwa
Ryoo Hun-Mo
Choi Jung-Hye
Ahn Myung-Ju
Yoon Hwi-Joong
Nam Sung-Hyun
Kim Bong-Seog
Seong Chu-Myong
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Abstract
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Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL).
Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up.
Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis.
Conclusions: Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.
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KEYWORD
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Leukemia, promyelocytic, acute, Cytarabine, Tretinoin, Idarubicin
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