Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study.
Outcome of older (≥70 years) APL patients frontline treated with or without arsenic trioxide-an International Collaborative Study.
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DOI：
10.1038/s41375-020-0758-4
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发表时间：
2020-09
期刊：
影响因子：
11.4
通讯作者：
Montesinos P
中科院分区：
文献类型：
--
作者：
Kayser S;Rahmé R;Martínez-Cuadrón D;Ghiaur G;Thomas X;Sobas M;Guerci-Bresler A;Garrido A;Pigneux A;Gil C;Raffoux E;Tormo M;Vey N;de la Serna J;Salamero O;Lengfelder E;Levis MJ;Fenaux P;Sanz MA;Platzbecker U;Schlenk RF;Adès L;Montesinos P
老年（≥70岁）急性早幼粒细胞白血病患者接受三氧化二砷（ATO）治疗与标准化疗（CTX）相比的结局数据很少。我们评估了433例患者（中位年龄73.4岁），接受ATO+全反式维甲酸（ATO/ATRA; n = 26）、CTX/ATRA +巩固期间ATO（CTX/ATRA/ATO; n = 148）或CTX/ATRA（n = 259）治疗。总生存期（OS）的中位随访时间为4.8年。ATO/ATRA组和CTX/ATRA组的完全缓解率分别为92%和82%;诱导死亡率分别为8%和18%。为了分析缓解后结果，我们将ATO/ATRA和CTX/ATRA/ATO组（ATO/ATRA ± CTX）合并。ATO/ATRA ± CTX组的累积复发率（CIR）明显低于CTX/ATRA组（P < 0.001）。在根据2000年以后的治疗期限制分析时，情况也是如此。ATO/ATRA ± CTX组与CTX/ATRA组相比，CR 1期患者的OS差异无统计学意义（P = 0.20）。在CTX/ATRA组中，诊断时高（>10 × 109/l）的白色细胞（WBC）计数与较高的CIR相关（P < 0.001），而在ATO/ATRA ± CTX组中则与较低的WBC计数无关（P = 0.48）。ATO与ATRA或CTX/ATRA联合应用对老年患者，特别是诊断时WBC高的患者，诱导缓解和巩固治疗是可行和有效的。
Data on outcome in older (≥70 years) patients with acute promyelocytic leukemia after treatment with arsenic trioxide (ATO) compared with standard chemotherapy (CTX) is scarce. We evaluated 433 patients (median age, 73.4 years) treated either with ATO+ all-trans retinoic acid (ATO/ATRA; n = 26), CTX/ATRA + ATO during consolidation (CTX/ATRA/ATO; n = 148), or with CTX/ATRA (n = 259). Median follow-up for overall survival (OS) was 4.8 years. Complete remissions (CR) were achieved in 92% with ATO/ATRA and 82% with CTX/ATRA; induction death rates were 8% and 18%, respectively. For analysis of postremission outcomes we combined the ATO/ATRA and CTX/ATRA/ATO groups (ATO/ATRA ± CTX). Cumulative incidence of relapse (CIR) was significantly lower after ATO/ATRA ± CTX compared with CTX/ATRA (P < 0.001). The same held true when restricting the analysis according to the treatment period after the year 2000. OS of patients in CR1 was not different between ATO/ATRA ± CTX compared with CTX/ATRA (P = 0.20). High (>10 × 109/l) white blood cell (WBC) counts at diagnosis were associated with higher CIR (P < 0.001) compared with lower WBC in the CTX/ATRA group, but not in the ATO/ATRA ± CTX group (P = 0.48). ATO, when added to ATRA or CTX/ATRA is feasible and effective in elderly patients for remission induction and consolidation, particularly in patients with high WBC at diagnosis.
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影响因子：
45.3
作者：
AdeS, Lionel;Chevret, Sylvie;Fenaux, Pierre
通讯作者：
Fenaux, Pierre
影响因子：
20.3
作者：
Lo-Coco, Francesco;Avvisati, Giuseppe;Mandelli, Franco
通讯作者：
Mandelli, Franco
影响因子：
11.4
作者：
Noguera, N;Breccia, M;Lo Coco, F
通讯作者：
Lo Coco, F
影响因子：
39.2
作者：
BENNETT, JM;CATOVSKY, D;SULTAN, C
通讯作者：
SULTAN, C
影响因子：
6.5
作者：
de Botton, S;Chevret, S;Fenaux, P
通讯作者：
Fenaux, P